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General NPI Number Information
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NPI Number | 1609305564
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Entity Type | Organization
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Legal Business Name | THE HIGHWAY: A SELF-HARM AND SUICIDE PREVENTION SERVICE
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7572 E BUENA VISTA DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-5563
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Country | US
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Telephone | 928-379-7016
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Fax | 928-255-4817
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Provider Business Mailing Address
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Address Line | 7572 E BUENA VISTA DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-5563
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Country | US
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Telephone | 928-379-7016
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Fax | 928-255-4817
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Authorized Official
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Title or Position | OWNER
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Name | CASSANDRA SMITH
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Credential |
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Telephone | 928-379-7016
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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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