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General NPI Number Information
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NPI Number | 1407420805
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Entity Type | Organization
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Legal Business Name | JOLLEY FAMILY BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 20104 W BROADWAY RD
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City | BUCKEYE
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State | AZ
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Zip | 85326-5753
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Country | US
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Telephone | 623-327-9573
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Fax |
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Provider Business Mailing Address
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Address Line | 9343 W PIONEER ST
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City | TOLLESON
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State | AZ
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Zip | 85353-1502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DEVIN PIERRE DUNCAN
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Credential |
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Telephone | 623-293-8900
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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 |
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License Number State |
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