Organization
MIKID, MENTALLY ILL KIDS IN DISTRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI L. JOHNSON (EXECUTIVE DIRECTOR)
(602) 253-1240
Entity
Organization
Contact information
Practice address
100 E 24TH ST, YUMA, AZ 85364-8619
(928) 726-2191
(928) 726-4052
Mailing address
2642 E THOMAS RD, PHOENIX, AZ 85016-8202
(602) 253-1240
(602) 253-1250
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CSA09ADHS0142 -2
AZ
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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