Provider Demographics
NPI:1417688821
Name:SEA GLASS MENTAL HEALTH INC
Entity Type:Organization
Organization Name:SEA GLASS MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABARZUA
Authorized Official - Suffix:
Authorized Official - Credentials:MC, LPC/LMHC, NCC
Authorized Official - Phone:623-238-1616
Mailing Address - Street 1:111 HEKILI ST STE A241
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2800
Mailing Address - Country:US
Mailing Address - Phone:623-238-1616
Mailing Address - Fax:
Practice Address - Street 1:7420 E CAMELBACK RD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3509
Practice Address - Country:US
Practice Address - Phone:480-256-2605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty