Provider Demographics
NPI:1821237256
Name:SURPRISE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:SURPRISE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRUEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMFT
Authorized Official - Phone:623-337-3388
Mailing Address - Street 1:19920 N CANYON WHISPER DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-7269
Mailing Address - Country:US
Mailing Address - Phone:623-337-3388
Mailing Address - Fax:623-322-1938
Practice Address - Street 1:15535 N REEMS RD
Practice Address - Street 2:SUITE 12
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9580
Practice Address - Country:US
Practice Address - Phone:623-337-3388
Practice Address - Fax:623-322-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty