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General NPI Number Information
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NPI Number | 1023823846
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Entity Type | Organization
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Legal Business Name | BEACON PSYCHIATRIC WELLNESS CENTER
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 12611 N 103RD AVE STE A
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City | SUN CITY
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State | AZ
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Zip | 85351-3422
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Country | US
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Telephone | 602-512-5506
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Fax |
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Provider Business Mailing Address
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Address Line | 12611 N 103RD AVE STE A
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City | SUN CITY
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State | AZ
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Zip | 85351-3422
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Country | US
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Telephone | 602-512-5506
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SAMUEL DOBOS
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Credential |
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Telephone | 602-512-5506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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