Provider Demographics
NPI:1093452203
Name:B2B BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:B2B BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-203-3519
Mailing Address - Street 1:2045 S VINEYARD
Mailing Address - Street 2:BLDG 1E, SUITE 115
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4512
Mailing Address - Country:US
Mailing Address - Phone:480-203-3519
Mailing Address - Fax:
Practice Address - Street 1:2045 S. VINEYARD BLDG 1E
Practice Address - Street 2:SUITE 115
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-935-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ145175Medicaid