Healthcare Provider Details

I. General information

NPI: 1467779744
Provider Name (Legal Business Name): BHP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15508 W BELL RD
SURPRISE AZ
85374-2432
US

IV. Provider business mailing address

15508 W BELL RD
SURPRISE AZ
85374-2432
US

V. Phone/Fax

Practice location:
  • Phone: 623-698-4746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3735
License Number StateAZ

VIII. Authorized Official

Name: BEAT BISENZ
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 623-698-4746