Provider Demographics
NPI:1639893738
Name:KASE, HENOK TEKA
Entity Type:Individual
Prefix:
First Name:HENOK
Middle Name:TEKA
Last Name:KASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 W WARNER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-0139
Mailing Address - Country:US
Mailing Address - Phone:602-386-6212
Mailing Address - Fax:
Practice Address - Street 1:6315 W WARNER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-0139
Practice Address - Country:US
Practice Address - Phone:602-386-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH7864251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health