NPI 1538590005

Tonya Randolph Smith

Practitioner Child Mental Illness Respite Care Avondale, AZ

Practice location

Address: 12227 W Hadley St, Avondale, AZ 85323-8434
Phone: (414) 617-8549

Registered specialties

Child Mental Illness Respite Care Primary

Respite Care Facility Taxonomy 385HR2055X Licence 3467447 (AZ)

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Registry record

NPI: 1538590005
Entity type: Individual
Sex (as registered): Female
NPI issued: 9 Dec 2013
Record last updated: 9 Dec 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.