Provider Demographics
NPI:1356076384
Name:PHABIAN, TERRELL
Entity Type:Individual
Prefix:MR
First Name:TERRELL
Middle Name:
Last Name:PHABIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 E WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1908
Mailing Address - Country:US
Mailing Address - Phone:623-692-2648
Mailing Address - Fax:
Practice Address - Street 1:4600 E WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1908
Practice Address - Country:US
Practice Address - Phone:623-692-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health