Healthcare Provider Details

I. General information

NPI: 1629432380
Provider Name (Legal Business Name): BEHAVIORAL CONSULTATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E CEDAR AVE STE A-6
FLAGSTAFF AZ
86004-1630
US

IV. Provider business mailing address

PO BOX 86537
TUCSON AZ
85754-6537
US

V. Phone/Fax

Practice location:
  • Phone: 800-771-9889
  • Fax: 928-563-0048
Mailing address:
  • Phone: 520-721-1887
  • Fax: 520-721-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSE MARY LOPEZ
Title or Position: PRESIDENT AND CEO
Credential: MBA
Phone: 520-721-1887