Healthcare Provider Details

I. General information

NPI: 1902993470
Provider Name (Legal Business Name): SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10-A WARD CANYON ROAD, ROOM 2
CLIFTON AZ
85533
US

IV. Provider business mailing address

P.O BOX 2161 611 W. UNION STREET
BENSON AZ
85602
US

V. Phone/Fax

Practice location:
  • Phone: 928-865-4531
  • Fax: 928-865-4821
Mailing address:
  • Phone: 520-586-0800
  • Fax: 520-586-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH2696
License Number StateAZ

VIII. Authorized Official

Name: MR. JOHN MOTOWSKI
Title or Position: CHIEF FINANCIAL OFFICER
Credential: M.S.
Phone: 520-586-0800