Provider Demographics
NPI:1639528078
Name:UNITED BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:UNITED BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAND
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, BCBA, LBA
Authorized Official - Phone:602-206-6046
Mailing Address - Street 1:3150 N 24TH ST STE C102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3150 N 24TH ST STE C102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7343
Practice Address - Country:US
Practice Address - Phone:602-206-6046
Practice Address - Fax:602-635-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-114251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1164832358OtherNPI PRIVATE