Provider Demographics
NPI:1538511886
Name:MARICOPA BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:MARICOPA BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WESTBY
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:480-993-9020
Mailing Address - Street 1:PO BOX 1617
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-1399
Mailing Address - Country:US
Mailing Address - Phone:480-993-9020
Mailing Address - Fax:
Practice Address - Street 1:19395 N JOHN WAYNE PKWY
Practice Address - Street 2:16
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2833
Practice Address - Country:US
Practice Address - Phone:993-480-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 11886251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health