Healthcare Provider Details

I. General information

NPI: 1093452203
Provider Name (Legal Business Name): B2B BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 S. VINEYARD BLDG 1E SUITE 115
MESA AZ
85210
US

IV. Provider business mailing address

2045 S VINEYARD BLDG 1E, SUITE 115
MESA AZ
85210-4512
US

V. Phone/Fax

Practice location:
  • Phone: 480-935-3449
  • Fax:
Mailing address:
  • Phone: 480-203-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: GLEN MAYBERRY
Title or Position: OWNER
Credential:
Phone: 480-203-3519