Provider Demographics
NPI:1568768190
Name:CANYONBEHAVIOR HEALTH
Entity Type:Organization
Organization Name:CANYONBEHAVIOR HEALTH
Other - Org Name:CANYON PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-507-2199
Mailing Address - Street 1:1825 E NORTHERN AVE
Mailing Address - Street 2:100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3940
Mailing Address - Country:US
Mailing Address - Phone:480-507-2199
Mailing Address - Fax:480-507-0611
Practice Address - Street 1:815 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8032
Practice Address - Country:US
Practice Address - Phone:480-507-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty