Provider Demographics
NPI:1134292485
Name:LITTLE COLORADO BEHAVIORAL HEALTH CENTER INC.
Entity Type:Organization
Organization Name:LITTLE COLORADO BEHAVIORAL HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:POCHE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:928-333-2683
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0579
Mailing Address - Country:US
Mailing Address - Phone:928-337-4301
Mailing Address - Fax:928-337-2269
Practice Address - Street 1:470 W CLEVELAND
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936-0579
Practice Address - Country:US
Practice Address - Phone:928-337-4301
Practice Address - Fax:928-337-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-2810101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ919053Medicaid
AZ919087Medicaid
AZ869381Medicaid
AZ821258Medicaid
AZ739138Medicaid
AZ821258Medicaid