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General NPI Number Information
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NPI Number | 1609071646
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Entity Type | Organization
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Legal Business Name | EMPACT-SUICIDE PREVENTION CENTER
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 618 S. MADISON DRIVE
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City | TEMPE
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State | AZ
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Zip | 85281-7248
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Country | US
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Telephone | 480-784-1514
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Fax | 480-967-3528
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Provider Business Mailing Address
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Address Line | 618 S. MADISON DRIVE
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City | TEMPE
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State | AZ
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Zip | 85281-7248
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Country | US
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Telephone | 480-784-1514
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Fax | 480-967-3528
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | LIZ MONTANO
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Credential |
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Telephone | 480-784-1514
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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 | BH 373
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH-4062
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License Number State | AZ
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