Provider Demographics
NPI:1598368714
Name:ARIZONA COMMUNITY OUTREACH
Entity Type:Organization
Organization Name:ARIZONA COMMUNITY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TELLEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-313-9448
Mailing Address - Street 1:6025 NORTH 27TH AVE. STE 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-1764
Mailing Address - Country:US
Mailing Address - Phone:602-313-9448
Mailing Address - Fax:
Practice Address - Street 1:6025 NORTH 27TH AVE. STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1764
Practice Address - Country:US
Practice Address - Phone:602-313-9448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health