Healthcare Provider Details

I. General information

NPI: 1790773620
Provider Name (Legal Business Name): SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W REX ALLEN DR
WILLCOX AZ
85643-1120
US

IV. Provider business mailing address

611 W UNION ST
BENSON AZ
85602-6718
US

V. Phone/Fax

Practice location:
  • Phone: 520-384-2521
  • Fax: 520-384-0543
Mailing address:
  • Phone: 520-586-0800
  • Fax: 520-586-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberBH-2672
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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