Healthcare Provider Details

I. General information

NPI: 1770651317
Provider Name (Legal Business Name): BEHAVIORAL AWARENESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 W ANKLAM RD
TUCSON AZ
85745-2148
US

IV. Provider business mailing address

2002 W ANKLAM RD
TUCSON AZ
85745-2148
US

V. Phone/Fax

Practice location:
  • Phone: 520-629-9126
  • Fax: 520-629-9282
Mailing address:
  • Phone: 520-629-9126
  • Fax: 520-629-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBH1448
License Number StateAZ

VIII. Authorized Official

Name: MR. BRACKIE D SEKAVEC
Title or Position: OWNER
Credential:
Phone: 520-629-9126