Healthcare Provider Details

I. General information

NPI: 1174305890
Provider Name (Legal Business Name): SEQUOIA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 S VINEYARD BLDG 5A
MESA AZ
85210-6871
US

IV. Provider business mailing address

2152 S VINEYARD BLDG 5A
MESA AZ
85210-6871
US

V. Phone/Fax

Practice location:
  • Phone: 928-460-0862
  • Fax: 480-307-6911
Mailing address:
  • Phone: 928-460-0862
  • Fax: 480-307-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SEAN PARSONS
Title or Position: CEO
Credential: AASM, CPLC
Phone: 928-460-0862