MEDICARE: CENTER FOR BEHAVIORAL HEALTH 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	BH-020	AZ
2	261QM2800X	Methadone Clinic		AZ

General Provider Information

NPI Number	:	1588722367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	5001 SPRING VALLEY ROAD
Second Line	:	SUITE 600 EAST
City	:	DALLAS
State	:	TX
Zip	:	75244-3946
Country	:	US
Telephone Number	:	214-365-6100
Fax Number	:	214-365-6150

Provider Business Practice Location Address
First Line	:	2123 EAST SOUTHERN AVENUE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282
Country	:	US
Telephone Number	:	480-897-7044
Fax Number	:	480-897-7943

Authorized Official
Title or Position	:	CEO
Name	:	JAY HIGHAM
Credential	:
Telephone Number	:	214-365-6112

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	12/26/2024

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