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NPI Code Detail

MEDICARE: ARIZONA YOUTH & FAMILY SERVICES, INC.

MEDICARE: ARIZONA YOUTH & FAMILY SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health AgencyBH2580AZ
2251S00000XCommunity/Behavioral Health Agency3547AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1942476OTHERAZAHCCCS

General Provider Information

NPI Number : 1124187141
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARIZONA YOUTH & FAMILY SERVICES, INC.
Provider Business Mailing Address
First Line : 3707 NORTH 7TH STREET
Second Line : SUITE 200
City : PHOENIX
State : AZ
Zip : 85014
Country : US
Telephone Number : 602-277-4833
Fax Number : 602-277-4820
Provider Business Practice Location Address
First Line : 3707 NORTH 7TH STREET
Second Line : SUITE 200
City : PHOENIX
State : AZ
Zip : 85014
Country : US
Telephone Number : 602-277-4833
Fax Number : 602-277-4820
Authorized Official
Title or Position : CEO
Name : MR. MARK ANTHONY NIXON
Credential : LCSW
Telephone Number : 602-277-4833
Provider Enumeration Date : 12/06/2006
Last Update Date : 10/19/2018

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