Healthcare Provider Details

I. General information

NPI: 1306265285
Provider Name (Legal Business Name): HIGHLAND BEHAVIORAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E MUIRWOOD DR SUITE 103
PHOENIX AZ
85048-7639
US

IV. Provider business mailing address

4530 E MUIRWOOD DR SUITE 103
PHOENIX AZ
85048-7639
US

V. Phone/Fax

Practice location:
  • Phone: 480-610-6981
  • Fax: 480-898-7419
Mailing address:
  • Phone: 480-610-6981
  • Fax: 480-898-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN DAVEY
Title or Position: PRESIDENT
Credential: PHD
Phone: 480-455-0987