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General NPI Number Information
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NPI Number | 1760589204
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Entity Type | Organization
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Legal Business Name | DOUGLAS ARC
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 610 9TH STREET
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City | DOUGLAS
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State | AZ
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Zip | 85607
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Country | US
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Telephone | 520-364-7473
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Fax | 520-364-2236
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Provider Business Mailing Address
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Address Line | PO BOX 252
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City | DOUGLAS
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State | AZ
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Zip | 85608
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Country | US
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Telephone | 520-364-7473
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Fax | 520-364-2236
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GARY J CLARK
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Credential |
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Telephone | 520-364-7473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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