Organization
STONEWALL INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE JAMISON PENNIMAN MSW, LISAC (CEO)
(602) 535-6468
Entity
Organization
Contact information
Practice address
4020 N 20TH ST STE 302, PHOENIX, AZ 85016-6032
(602) 535-6468
Mailing address
4020 N 20TH ST STE 302, PHOENIX, AZ 85016-6032
(602) 535-6468
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH3856
AZ
Other
Enumeration date
10/06/2009
Last updated
07/27/2012
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