Healthcare Provider Details

I. General information

NPI: 1295660520
Provider Name (Legal Business Name): PEAKS YOUTH BEHAVORAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 DAMERON DR STE B
PRESCOTT AZ
86301-2411
US

IV. Provider business mailing address

642 DAMERON DR STE B
PRESCOTT AZ
86301-2411
US

V. Phone/Fax

Practice location:
  • Phone: 928-848-6941
  • Fax:
Mailing address:
  • Phone: 928-848-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MAKENZIE STIDHAM
Title or Position: MEMBER MANAGER
Credential:
Phone: 928-848-6941