Provider Demographics
NPI:1598373037
Name:TRIPLE PPP INTEGRATIVE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:TRIPLE PPP INTEGRATIVE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-226-2044
Mailing Address - Street 1:5201 W SUNLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2431
Mailing Address - Country:US
Mailing Address - Phone:480-226-2044
Mailing Address - Fax:
Practice Address - Street 1:2538 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-6917
Practice Address - Country:US
Practice Address - Phone:480-226-2044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)