Healthcare Provider Details

I. General information

NPI: 1831756659
Provider Name (Legal Business Name): MOHAVE MENTAL HEALTH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 SYCAMORE AVE
KINGMAN AZ
86409-0927
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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