Provider Demographics
NPI:1194378158
Name:CASBRA BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:CASBRA BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DIAZ DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, BSN
Authorized Official - Phone:520-225-8465
Mailing Address - Street 1:1152 N HOHOKAM DR STE 4
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1373
Mailing Address - Country:US
Mailing Address - Phone:520-225-8465
Mailing Address - Fax:
Practice Address - Street 1:1152 N HOHOKAM DR STE 4
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1373
Practice Address - Country:US
Practice Address - Phone:520-225-8465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ374908Medicaid