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General NPI Number Information
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NPI Number | 1407026651
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Entity Type | Organization
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Legal Business Name | SAGE MEMORIAL HOSPITAL BEHAVIORAL HEALTH CLINIC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | US 191 & AZ 264 SALSBURY HALL SAGE MEMORIAL HOSPITAL CAMPUS
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City | GANADO
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State | AZ
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Zip | 86505
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Country | US
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Telephone | 928-755-4500
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Fax | 928-755-4934
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Provider Business Mailing Address
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Address Line | PO BOX 457
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City | GANADO
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State | AZ
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Zip | 86505-0457
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Country | US
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Telephone | 928-755-4500
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Fax | 928-755-4747
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Authorized Official
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Title or Position | MEDICAL STAFF CREDENTIALIST
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Name | MRS. ANDREA CURLEY
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Credential |
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Telephone | 928-755-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5168T
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 11643
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 13084
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License Number State | AZ
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