Healthcare Provider Details

I. General information

NPI: 1780008672
Provider Name (Legal Business Name): MENTALLY ILL KIDS IN DISTRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 S PACIFIC AVE
YUMA AZ
85365-3512
US

IV. Provider business mailing address

7816 N 19TH AVE
PHOENIX AZ
85021-7036
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-1983
  • Fax: 928-493-3976
Mailing address:
  • Phone: 602-253-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MATT AUNA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: BHT
Phone: 602-253-1240