Healthcare Provider Details

I. General information

NPI: 1326215955
Provider Name (Legal Business Name): SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 CAMPUS DRIVE
SIERRA VISTA AZ
85635
US

IV. Provider business mailing address

611 W UNION ST
BENSON AZ
85602-6718
US

V. Phone/Fax

Practice location:
  • Phone: 520-458-3932
  • Fax: 520-458-3585
Mailing address:
  • Phone: 520-586-0800
  • Fax: 520-586-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH-3043
License Number StateAZ

VIII. Authorized Official

Name: KATHY WELLS
Title or Position: EVP/COO
Credential:
Phone: 520-838-5501