Healthcare Provider Details

I. General information

NPI: 1194440842
Provider Name (Legal Business Name): SABA INTEGRATED BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W NORTHERN AVE STE 101
PHOENIX AZ
85021-5400
US

IV. Provider business mailing address

5045 W BASELINE RD STE 105
LAVEEN AZ
85339-7397
US

V. Phone/Fax

Practice location:
  • Phone: 602-736-9647
  • Fax:
Mailing address:
  • Phone: 480-352-5490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. OMETRIS KING
Title or Position: ADMINSTRATOR
Credential: LPC
Phone: 480-352-5490