Healthcare Provider Details

I. General information

NPI: 1003273855
Provider Name (Legal Business Name): MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W BROWN RD
MESA AZ
85201-3227
US

IV. Provider business mailing address

PO BOX 29670
PHOENIX AZ
85038-9670
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-8178
  • Fax: 602-344-8122
Mailing address:
  • Phone: 602-344-8178
  • Fax: 602-344-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberH3673
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberH3673
License Number StateAZ

VIII. Authorized Official

Name: KATHLEEN KIRKLAND
Title or Position: PFS DIRECTOR
Credential:
Phone: 602-344-8178