Provider Demographics
NPI:1235318130
Name:ARIZONA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ARIZONA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-997-6635
Mailing Address - Street 1:7330 N. 16TH ST.
Mailing Address - Street 2:SUITE A-120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-997-6635
Mailing Address - Fax:602-997-6642
Practice Address - Street 1:7330 N. 16TH ST.
Practice Address - Street 2:SUITE A-120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-997-6635
Practice Address - Fax:602-997-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 03941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27615Medicare UPIN
Z27615Medicare PIN