Provider Demographics
NPI:1407596877
Name:BBC SCOTTSDALE LLC
Entity Type:Organization
Organization Name:BBC SCOTTSDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:GEOR-ZELL
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-660-5775
Mailing Address - Street 1:1113 E GURLEY ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3309
Mailing Address - Country:US
Mailing Address - Phone:480-660-5775
Mailing Address - Fax:
Practice Address - Street 1:1113 E GURLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3309
Practice Address - Country:US
Practice Address - Phone:480-660-5775
Practice Address - Fax:602-926-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health