Organization
KETAMINE PSYCHOLYTIC THERAPY LLC
Active
Organization
KETAMINE PSYCHOLYTIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL CUNNINGHAM MD (OWNER)
(610) 730-9097
Entity
Organization
Contact information
Practice address
45 CASTLE ROCK ROAD STE 2A, SEDONA, AZ 86351
(928) 814-5269
Mailing address
45 CASTLE ROCK ROAD STE 2A, SEDONA, AZ 86351
(610) 730-9097
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
12/07/2021
Last updated
03/08/2022
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