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
1	251S00000X	Community/Behavioral Health Agency	BH2580	AZ
2	251S00000X	Community/Behavioral Health Agency	3547	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	942476	OTHER	AZ	AHCCCS

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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