BLACK MOUNTAIN BEHAVIORAL HEALTH, LLC

Provider Demographics

• NPI: 1639589930
• Name: BLACK MOUNTAIN BEHAVIORAL HEALTH, LLC
• Entity Type: Organization
• Organization Name: BLACK MOUNTAIN BEHAVIORAL HEALTH, LLC
• Authorized Official - Title/Position: EXECUTIVE DIRECTOR
• Authorized Official - Prefix: DR
• Authorized Official - First Name: KONSTANTINOS
• Authorized Official - Middle Name: DIMITRIOS
• Authorized Official - Last Name: THOMOPOULOS
• Authorized Official - Credentials: PSYD
• Authorized Official - Phone: 480-595-1555
• Mailing Address - Street 1: 33755 N SCOTTSDALE RD
• Mailing Address - Street 2: SUITE J-105
• Mailing Address - City: SCOTTSDALE
• Mailing Address - State: AZ
• Mailing Address - Zip Code: 85266-1567
• Mailing Address - Country: US
• Mailing Address - Phone: 480-595-1555
• Mailing Address - Fax: 866-307-0007
• Practice Address - Street 1: 33755 N SCOTTSDALE RD
• Practice Address - Street 2: SUITE J-105
• Practice Address - City: SCOTTSDALE
• Practice Address - State: AZ
• Practice Address - Zip Code: 85266-1567
• Practice Address - Country: US
• Practice Address - Phone: 480-595-1555
• Practice Address - Fax: 866-307-0007
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2014-05-08
• Last Update Date: 2014-05-08

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QR0405X	Ambulatory Health Care Facilities	Clinic/Center	Rehabilitation, Substance Use Disorder	Group - Multi-Specialty
No	103G00000X	Behavioral Health & Social Service Providers	Clinical Neuropsychologist		Group - Multi-Specialty
No	103TA0400X	Behavioral Health & Social Service Providers	Psychologist	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	103TA0700X	Behavioral Health & Social Service Providers	Psychologist	Adult Development & Aging	Group - Multi-Specialty
No	103TB0200X	Behavioral Health & Social Service Providers	Psychologist	Cognitive & Behavioral	Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	103TC2200X	Behavioral Health & Social Service Providers	Psychologist	Clinical Child & Adolescent	Group - Multi-Specialty
No	103TF0000X	Behavioral Health & Social Service Providers	Psychologist	Family	Group - Multi-Specialty
No	103TF0200X	Behavioral Health & Social Service Providers	Psychologist	Forensic	Group - Multi-Specialty
No	103TH0004X	Behavioral Health & Social Service Providers	Psychologist	Health	Group - Multi-Specialty
No	103TP2701X	Behavioral Health & Social Service Providers	Psychologist	Group Psychotherapy	Group - Multi-Specialty
No	103TR0400X	Behavioral Health & Social Service Providers	Psychologist	Rehabilitation	Group - Multi-Specialty
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health
No	261QM0855X	Ambulatory Health Care Facilities	Clinic/Center	Adolescent and Children Mental Health