Provider Demographics
NPI:1629624911
Name:MILAGRO BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MILAGRO BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:520-990-8107
Mailing Address - Street 1:6375 E TANQUE VERDE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3863
Mailing Address - Country:US
Mailing Address - Phone:520-885-4679
Mailing Address - Fax:520-296-9556
Practice Address - Street 1:6375 E TANQUE VERDE RD STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3863
Practice Address - Country:US
Practice Address - Phone:520-885-4679
Practice Address - Fax:520-296-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty