Healthcare Provider Details

I. General information

NPI: 1609305564
Provider Name (Legal Business Name): THE HIGHWAY: A SELF-HARM AND SUICIDE PREVENTION SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7572 E BUENA VISTA DR
PRESCOTT VALLEY AZ
86314-5563
US

IV. Provider business mailing address

7572 E BUENA VISTA DR
PRESCOTT VALLEY AZ
86314-5563
US

V. Phone/Fax

Practice location:
  • Phone: 928-379-7016
  • Fax: 928-255-4817
Mailing address:
  • Phone: 928-379-7016
  • Fax: 928-255-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA SMITH
Title or Position: OWNER
Credential:
Phone: 928-379-7016