MEDICARE: TEEVAGA BEHAVIORAL HEALTH SERVICES LLC

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

General Provider Information

NPI Number	:	1174311922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEEVAGA BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	7935 W ATLANTIS WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7935 W ATLANTIS WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1638
Country	:	US
Telephone Number	:	480-202-5465
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/BHT
Name	:	EFEEVELYN AGBIWE
Credential	:
Telephone Number	:	480-202-5465

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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