Provider Demographics
NPI:1811215213
Name:ARIZONA BEHAVIORAL RESOURCES, PLLC
Entity Type:Organization
Organization Name:ARIZONA BEHAVIORAL RESOURCES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:602-910-5653
Mailing Address - Street 1:7000 N 16TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5547
Mailing Address - Country:US
Mailing Address - Phone:602-910-5653
Mailing Address - Fax:
Practice Address - Street 1:7000 N 16TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5547
Practice Address - Country:US
Practice Address - Phone:602-910-5653
Practice Address - Fax:602-374-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-12066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ527879Medicaid
AZ1174724439Medicare PIN