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General NPI Number Information
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NPI Number | 1043615412
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Entity Type | Organization
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Legal Business Name | TELECARE MENTAL HEALTH SERVICES OF ARIZONA INC
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 1595 S 1ST AVE
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City | YUMA
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State | AZ
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Zip | 85364-4706
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Country | US
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Telephone | 928-329-5855
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Fax | 928-329-5904
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Provider Business Mailing Address
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Address Line | 1080 MARINA VILLAGE PARKWAY SUITE 100
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City | ALAMEDA
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State | CA
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Zip | 94501-1087
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Country | US
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Telephone | 510-337-7950
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Fax | 510-337-7969
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Authorized Official
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Title or Position | PROVIDER RELATIONS SUPERVISOR
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Name | LORENA LOPEZ
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Credential |
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Telephone | 510-337-7950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | OTC6996
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License Number State | AZ
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