Organization
MARK ALLEN FDT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONA MARIA HARMS BEHAVIORAL HEALTH TE (EXECUTIVE DIRECTOR)
(602) 973-3727
Entity
Organization
Contact information
Practice address
2622 W STATE AVE, PHOENIX, AZ 85051
(602) 973-3727
(602) 841-2864
Mailing address
2622 W STATE AVE, PHOENIX, AZ 85051
(602) 973-3727
(602) 841-2864
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
754342
AHCUS
AZ
Enumeration date
06/20/2006
Last updated
08/22/2020
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