Healthcare Provider Details

I. General information

NPI: 1053079780
Provider Name (Legal Business Name): ALLIED BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W RAY RD STE B6
CHANDLER AZ
85225-7264
US

IV. Provider business mailing address

600 W RAY RD STE B6
CHANDLER AZ
85225-7264
US

V. Phone/Fax

Practice location:
  • Phone: 602-693-4230
  • Fax:
Mailing address:
  • Phone: 602-693-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ABDIQANI ADAM
Title or Position: CEO
Credential:
Phone: 480-287-4545