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General NPI Number Information
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NPI Number | 1538290119
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Entity Type | Organization
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Legal Business Name | RAINBOW TREATMENT CENTER WHITE MOUNTAIN APACHE TRIBE
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 WEST PONDERSOSA
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City | WHITERIVER
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State | AZ
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Zip | 85941-1790
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Country | US
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Telephone | 928-338-4858
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Fax | 928-338-4100
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Provider Business Mailing Address
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Address Line | 302 WEST PONDERSOSA
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City | WHITERIVER
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State | AZ
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Zip | 85941-1790
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Country | US
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Telephone | 928-338-4858
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Fax | 928-338-4100
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BLL ARNETT
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Credential | PSY.D.
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Telephone | 928-338-4858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 541484
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License Number State | AZ
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