Provider Demographics
NPI:1396987459
Name:ARIZONA BEHAVIORAL HEALTH CENTER PC
Entity type:Organization
Organization Name:ARIZONA BEHAVIORAL HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOLLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISAC
Authorized Official - Phone:602-343-8232
Mailing Address - Street 1:2600 N 44TH ST
Mailing Address - Street 2:SUITE B104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-1521
Mailing Address - Country:US
Mailing Address - Phone:602-343-8232
Mailing Address - Fax:602-343-8233
Practice Address - Street 1:2600 N 44TH ST
Practice Address - Street 2:SUITE B104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1521
Practice Address - Country:US
Practice Address - Phone:602-343-8232
Practice Address - Fax:602-343-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty