Provider Demographics
NPI:1376209916
Name:MY BEHAVIORAL HEALTH TREATMENT CENTER (MYBHTC)
Entity Type:Organization
Organization Name:MY BEHAVIORAL HEALTH TREATMENT CENTER (MYBHTC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-888-6779
Mailing Address - Street 1:3039 W PEORIA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5212
Mailing Address - Country:US
Mailing Address - Phone:602-888-6779
Mailing Address - Fax:312-610-5767
Practice Address - Street 1:19840 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1226
Practice Address - Country:US
Practice Address - Phone:602-888-6779
Practice Address - Fax:312-610-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No291U00000XLaboratoriesClinical Medical Laboratory
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child