Healthcare Provider Details

I. General information

NPI: 1366941361
Provider Name (Legal Business Name): PARAMOUNT BEHAVIORAL HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 09/12/2025
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 W BURNSIDE TRL
PHOENIX AZ
85085-8071
US

IV. Provider business mailing address

PO BOX 10727
GLENDALE AZ
85318-0727
US

V. Phone/Fax

Practice location:
  • Phone: 623-225-6220
  • Fax: 623-518-2349
Mailing address:
  • Phone: 623-225-6220
  • Fax: 623-518-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number45661
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4900
License Number StateAZ

VIII. Authorized Official

Name: ELISE BALLOU
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHYSICIAN ASSISTANT
Phone: 623-225-6220