Individual
MAYRA KMETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8147 N CEDAR ST, WILLIAMS, AZ 86046-9642
(928) 607-0220
Mailing address
700 QUARTER HORSE RD, WILLIAMS, AZ 86046-9519
(928) 607-0220
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
2638357
AZ
385HR2055X
Child Mental Illness Respite Care
2638357
AZ
Other
Enumeration date
04/18/2011
Last updated
02/04/2021
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