Organization
MINDFLEX OUTPATIENT TREATMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOLA OKOUGBO (OWNER)
(602) 880-4214
Entity
Organization
Contact information
Practice address
5447 E 5TH ST, TUCSON, AZ 85711-2344
(602) 880-4214
Mailing address
5447 E 5TH ST, TUCSON, AZ 85711-2344
(602) 880-4214
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC12289
AZDHS
AZ
Enumeration date
02/21/2023
Last updated
02/21/2023
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