Healthcare Provider Details

I. General information

NPI: 1225414881
Provider Name (Legal Business Name): CHILD CRISIS ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W UNIVERSITY DR
MESA AZ
85201-5836
US

IV. Provider business mailing address

817 NORTH COUNTRY CLUB DRIVE
MESA AZ
85201
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-9424
  • Fax:
Mailing address:
  • Phone: 480-834-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSLG 7172
License Number StateAZ

VIII. Authorized Official

Name: RICK SILAJ
Title or Position: SENIOR ACCOUNTANT
Credential:
Phone: 480-304-4320