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General NPI Number Information
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NPI Number | 1790773620
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICE, INC.
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 404 W REX ALLEN DR
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City | WILLCOX
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State | AZ
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Zip | 85643-1120
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Country | US
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Telephone | 520-384-2521
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Fax | 520-384-0543
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Provider Business Mailing Address
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Address Line | 611 W UNION ST
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City | BENSON
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State | AZ
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Zip | 85602-6718
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Country | US
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Telephone | 520-586-0800
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Fax | 520-586-0116
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Authorized Official
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Title or Position | EVP/COO
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Name | KATHY GUZMAN WELLS
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Credential |
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Telephone | 520-838-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | BH-2672
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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