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General NPI Number Information
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NPI Number | 1235182262
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Entity Type | Organization
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Legal Business Name | BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 925 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85006-2502
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Country | US
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Telephone | 602-239-6800
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Fax | 602-239-4362
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Provider Business Mailing Address
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Address Line | 1441 N 12TH ST
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City | PHOENIX
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State | AZ
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Zip | 85006-2837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR VICE PRESIDENT - FINANCE
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Name | DENNIS E DAHLEN
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Credential |
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Telephone | 602-747-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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