Healthcare Provider Details

I. General information

NPI: 1699910877
Provider Name (Legal Business Name): BEHAVIORAL CONSULTATION SERVICES OF NORTHERN ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 W UNIVERSITY AVE SUITE 120
FLAGSTAFF AZ
86001-2986
US

IV. Provider business mailing address

906 W UNIVERSITY AVE SUITE 120
FLAGSTAFF AZ
86001-2986
US

V. Phone/Fax

Practice location:
  • Phone: 928-522-3780
  • Fax: 928-526-2119
Mailing address:
  • Phone: 928-522-3780
  • Fax: 928-526-2119

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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW GARDNER
Title or Position: DIRECTOR OF SERVICES
Credential: PHD, BCBA-D
Phone: 928-522-3780