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General NPI Number Information
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NPI Number | 1558336818
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Entity Type | Organization
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Legal Business Name | ARIZONA BEHAVIORAL HEALTH ASSOCIATES, P.C.
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 710 N BEAVER ST BLDG 4
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3139
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Country | US
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Telephone | 928-774-7997
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Fax |
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Provider Business Mailing Address
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Address Line | 710 N BEAVER ST BLDG 4
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3139
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Country | US
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Telephone | 928-774-7997
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. LEE LUSK
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Credential | M.A.
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Telephone | 928-774-7997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3232
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License Number State | AZ
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