Provider Demographics
NPI:1841434008
Name:SUN CITY BEHAVIORAL HEALTH CARE
Entity type:Organization
Organization Name:SUN CITY BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISW
Authorized Official - Phone:915-351-4680
Mailing Address - Street 1:2931 MONTANA AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903
Mailing Address - Country:US
Mailing Address - Phone:915-566-8228
Mailing Address - Fax:915-566-1019
Practice Address - Street 1:2931 MONTANA AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903
Practice Address - Country:US
Practice Address - Phone:915-566-8224
Practice Address - Fax:915-566-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB100242Medicare PIN