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General NPI Number Information
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NPI Number | 1538511886
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Entity Type | Organization
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Legal Business Name | MARICOPA BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 19395 N JOHN WAYNE PKWY 16
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City | MARICOPA
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State | AZ
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Zip | 85139-2833
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Country | US
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Telephone | 993-480-9020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1617
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City | MARICOPA
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State | AZ
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Zip | 85139-1399
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Country | US
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Telephone | 480-993-9020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FREDERICK THOMAS WESTBY
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Credential | LISAC
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Telephone | 480-993-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LISAC 11886
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License Number State | AZ
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