Provider Demographics
NPI:1871266155
Name:TELLURIAN BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:TELLURIAN BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NASSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-430-5491
Mailing Address - Street 1:111 N DUPONT CIR UNIT 374
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1853
Mailing Address - Country:US
Mailing Address - Phone:480-430-5491
Mailing Address - Fax:
Practice Address - Street 1:3849 E SHEENA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5732
Practice Address - Country:US
Practice Address - Phone:480-430-5491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health