Healthcare Provider Details

I. General information

NPI: 1083531370
Provider Name (Legal Business Name): EMPACT - SUICIDE PREVENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E JEFFERSON ST
PHOENIX AZ
85034-2295
US

IV. Provider business mailing address

618 S MADISON DR
TEMPE AZ
85281-7248
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax:
Mailing address:
  • Phone: 480-784-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HOUDE
Title or Position: CREDENTIALING
Credential:
Phone: 928-642-5583