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General NPI Number Information
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NPI Number | 1053573592
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Entity Type | Organization
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Legal Business Name | CONSTRUYENDO CIRCULOS DE PAZ, INC.
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 1859 N GRAND AVE SUITES 3 & 4
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City | NOGALES
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State | AZ
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Zip | 85621-1386
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Country | US
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Telephone | 520-281-0579
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Fax | 520-281-0493
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Provider Business Mailing Address
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Address Line | 1859 N GRAND AVE SUITES 3 & 4
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City | NOGALES
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State | AZ
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Zip | 85621-1386
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Country | US
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Telephone | 520-281-0579
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Fax | 520-281-0493
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. PATTI RAE WATSON
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Credential | ED.D.
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Telephone | 520-281-0579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH-3001
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License Number State | AZ
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