Organization
MIKID, MENTALLY ILL KIDS IN DISTRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKI LYNN JOHNSON M.A. (EXECUTIVE DIRECTOR)
(602) 253-1240
Entity
Organization
Contact information
Practice address
755 E WILLETTA ST, STE 128, PHOENIX, AZ 85006-2723
(602) 253-1240
(602) 253-1250
Mailing address
755 E WILLETTA ST, STE 128, PHOENIX, AZ 85006-2723
(602) 253-1240
(602) 253-1250
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
CSA05VO0142
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
757114
—
AZ
Enumeration date
06/30/2006
Last updated
08/22/2020
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