Provider Demographics
NPI:1558336818
Name:ARIZONA BEHAVIORAL HEALTH ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ARIZONA BEHAVIORAL HEALTH ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-774-7997
Mailing Address - Street 1:710 N BEAVER ST
Mailing Address - Street 2:BLDG 4
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3139
Mailing Address - Country:US
Mailing Address - Phone:928-774-7997
Mailing Address - Fax:
Practice Address - Street 1:710 N BEAVER ST
Practice Address - Street 2:BLDG 4
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3139
Practice Address - Country:US
Practice Address - Phone:928-774-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103G00000X, 103TS0200X, 261QR1300X, 390200000X
AZ3232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ77180Medicare ID - Type Unspecified