Provider Demographics
NPI:1780857847
Name:MAGELLAN HEALTH SERVICES
Entity Type:Organization
Organization Name:MAGELLAN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC0821
Authorized Official - Phone:602-252-6731
Mailing Address - Street 1:1035 E JEFFERSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-2295
Mailing Address - Country:US
Mailing Address - Phone:602-252-6731
Mailing Address - Fax:602-252-5928
Practice Address - Street 1:1035 E JEFFERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2295
Practice Address - Country:US
Practice Address - Phone:602-252-6731
Practice Address - Fax:602-252-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC0821302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization