Healthcare Provider Details

I. General information

NPI: 1730095134
Provider Name (Legal Business Name): COPPERLEAF BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 S SHIVWITS DR
SCENIC AZ
86432-3383
US

IV. Provider business mailing address

4539 N 22ND ST STE N
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 435-705-7574
  • Fax:
Mailing address:
  • Phone: 435-705-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TASHA LOPEZ
Title or Position: LICESNING
Credential:
Phone: 435-705-7574