Healthcare Provider Details

I. General information

NPI: 1750450532
Provider Name (Legal Business Name): AMERICAN INDIAN PREVENTION COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 N 7TH ST
PHOENIX AZ
85006-1602
US

IV. Provider business mailing address

PO BOX 25047
PHOENIX AZ
85002-5047
US

V. Phone/Fax

Practice location:
  • Phone: 602-424-1600
  • Fax: 602-532-7202
Mailing address:
  • Phone: 602-424-1600
  • Fax: 602-532-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: MS. BONNY M BEACH
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 602-432-3098