Healthcare Provider Details

I. General information

NPI: 1558336818
Provider Name (Legal Business Name): ARIZONA BEHAVIORAL HEALTH ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N BEAVER ST BLDG 4
FLAGSTAFF AZ
86001-3139
US

IV. Provider business mailing address

710 N BEAVER ST BLDG 4
FLAGSTAFF AZ
86001-3139
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-7997
  • Fax:
Mailing address:
  • Phone: 928-774-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3232
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE LUSK
Title or Position: MANAGING DIRECTOR
Credential: M.A.
Phone: 928-774-7997