Organization
MOGOLLON TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUSTIN HERACLES BULLARD (OWNER)
(928) 466-4242
Entity
Organization
Contact information
Practice address
3338 W KINGS AVE, PHOENIX, AZ 85053-2940
(928) 466-4242
Mailing address
306 W AERO DR, PAYSON, AZ 85541-5405
(928) 466-4242
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/27/2025
Last updated
12/12/2025
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