Healthcare Provider Details

I. General information

NPI: 1871665596
Provider Name (Legal Business Name): MOHAVE MENTAL HEALTH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 AIRWAY AVE STE A
KINGMAN AZ
86409-3573
US

IV. Provider business mailing address

3707 N STOCKTON HILL RD STE B
KINGMAN AZ
86409-0507
US

V. Phone/Fax

Practice location:
  • Phone: 928-718-4800
  • Fax: 928-757-3256
Mailing address:
  • Phone: 928-757-8111
  • Fax: 928-757-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberBH2060
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberOTC7272
License Number StateAZ

VIII. Authorized Official

Name: MS. DAWN D ABBOTT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MA, LPC
Phone: 928-757-8111