Healthcare Provider Details

I. General information

NPI: 1184545238
Provider Name (Legal Business Name): EMMANUEL BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W NORTHERN AVE STE 202F
PHOENIX AZ
85021-5471
US

IV. Provider business mailing address

1717 W NORTHERN AVE STE 202
PHOENIX AZ
85021-5471
US

V. Phone/Fax

Practice location:
  • Phone: 408-791-4817
  • Fax:
Mailing address:
  • Phone: 408-791-4817
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL FINGI
Title or Position: OWNER
Credential:
Phone: 602-632-3945