Healthcare Provider Details

I. General information

NPI: 1083916035
Provider Name (Legal Business Name): SAN TAN BEHAVIORAL HEALTH SVCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9648 E. JACOB CIRCLE
MESA AZ
85209
US

IV. Provider business mailing address

2451 E BASELINE ROAD STE 430
GILBERT AZ
85234
US

V. Phone/Fax

Practice location:
  • Phone: 480-588-7731
  • Fax: 480-632-0026
Mailing address:
  • Phone: 480-507-3644
  • Fax: 480-632-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-10764
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License NumberBH-3658
License Number StateAZ

VIII. Authorized Official

Name: MR. RICHARD WARREN ARBOGAST
Title or Position: CEO
Credential:
Phone: 480-773-2384