Provider Demographics
NPI:1073938684
Name:EMPACT SUICIDE PREVENTION CENTER
Entity Type:Organization
Organization Name:EMPACT SUICIDE PREVENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON-HUFFAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-784-1514
Mailing Address - Street 1:618 S MADISON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-7248
Mailing Address - Country:US
Mailing Address - Phone:480-784-1514
Mailing Address - Fax:480-736-4939
Practice Address - Street 1:460 N MESA DR
Practice Address - Street 2:SUITE 115
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5973
Practice Address - Country:US
Practice Address - Phone:480-833-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health