Healthcare Provider Details

I. General information

NPI: 1396987459
Provider Name (Legal Business Name): ARIZONA BEHAVIORAL HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15661 W IMPALA DR
CASA GRANDE AZ
85122-7461
US

IV. Provider business mailing address

PO BOX 65511
PHOENIX AZ
85082-5511
US

V. Phone/Fax

Practice location:
  • Phone: 602-343-8232
  • Fax: 602-343-8233
Mailing address:
  • Phone: 602-343-8232
  • Fax: 602-343-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. LAKSHMI R NOLLETTI
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: LCSW, LISAC
Phone: 602-343-8232