=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184224446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIERRABEHAVIORALHEALTH.LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2020
-----------------------------------------------------
Last Update Date | 10/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18427 N 33RD AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85053-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-907-4541
-----------------------------------------------------
Fax | 602-907-4562
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18427 N 33RD AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85053-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-907-4541
-----------------------------------------------------
Fax | 602-907-4562
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATION
-----------------------------------------------------
Name | LAMETRIE SINGLETARY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-424-7508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------