Individual
STEVEN ILLERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3854 HEATHER AVE, KINGMAN, AZ 86401-3844
(702) 219-0881
(928) 774-2159
Mailing address
3854 HEATHER AVE, KINGMAN, AZ 86401-3844
(805) 868-7581
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
8122828
AZ
385HR2055X
Child Mental Illness Respite Care
8122828
AZ
Other
Enumeration date
11/30/2016
Last updated
02/04/2021
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