Healthcare Provider Details

I. General information

NPI: 1962314773
Provider Name (Legal Business Name): EAST VALLEY BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W RAY RD STE 201
CHANDLER AZ
85226-2472
US

IV. Provider business mailing address

3100 W RAY RD STE 201
CHANDLER AZ
85226-2472
US

V. Phone/Fax

Practice location:
  • Phone: 480-907-8509
  • Fax:
Mailing address:
  • Phone: 480-907-8509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA WAGNER
Title or Position: OWNER/MEMBER
Credential: PHD
Phone: 480-907-8509