DOMINIQUE GIST

Psychiatric Residential Treatment Facility

Active Individual

NPI: 1629674742

Practice Address

8674 S 165TH AVE
Goodyear, AZ 85338

Specialties

Specialty	Code	Primary	License
Community Based Residential Treatment Facility, Mental Illness	320800000X	No	-
Community/Behavioral Health	251S00000X	No	-
Substance Abuse Rehabilitation Facility	324500000X	No	-
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy	332800000X	No	-
Psychiatric Residential Treatment Facility	323P00000X	Yes	-

Frequently Asked Questions

NPI 1629674742 is the National Provider Identifier for DOMINIQUE GIST, a Psychiatric Residential Treatment Facility provider located in Goodyear, AZ. This NPI was enumerated on December 5, 2020.

DOMINIQUE GIST practices at 8674 S 165TH AVE, Goodyear, AZ 85338.

Quick Facts

NPI: 1629674742
Type: Individual
Enumerated: Dec 5, 2020
Last Updated: Dec 5, 2020

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