Provider Demographics
NPI:1568912756
Name:ARTISAN BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:ARTISAN BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LISAC
Authorized Official - Phone:480-659-8245
Mailing Address - Street 1:PO BOX 27228
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-7228
Mailing Address - Country:US
Mailing Address - Phone:480-659-8245
Mailing Address - Fax:480-471-8186
Practice Address - Street 1:4450 S RURAL RD
Practice Address - Street 2:SUITE E-125
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7037
Practice Address - Country:US
Practice Address - Phone:480-659-8245
Practice Address - Fax:480-471-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11856101YA0400X
AZLPC-13296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty