Healthcare Provider Details

I. General information

NPI: 1235318130
Provider Name (Legal Business Name): ARIZONA BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 N. 16TH ST. SUITE A-120
PHOENIX AZ
85020
US

IV. Provider business mailing address

7330 N. 16TH ST. SUITE A-120
PHOENIX AZ
85020
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-6635
  • Fax: 602-997-6642
Mailing address:
  • Phone: 602-997-6635
  • Fax: 602-997-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 0394
License Number StateAZ

VIII. Authorized Official

Name: MR. OWEN GOLDEN JR.
Title or Position: PARTNER
Credential: LCSW
Phone: 602-997-6635