Provider Demographics
NPI:1922761204
Name:ARIZONA BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:ARIZONA BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:POLIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-343-8282
Mailing Address - Street 1:2600 N 44TH ST # B-104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-1521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 N 44TH ST STE B-104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1521
Practice Address - Country:US
Practice Address - Phone:602-343-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty