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General NPI Number Information
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NPI Number | 1902894272
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Entity Type | Organization
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Legal Business Name | MOHAVE MENTAL HEALTH CLINIC INC
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 3505 WESTERN AVE STE A
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City | KINGMAN
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State | AZ
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Zip | 86409-3074
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Country | US
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Telephone | 928-757-8111
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Fax | 928-757-3256
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Provider Business Mailing Address
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Address Line | 3707 N STOCKTON HILL RD STE B
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City | KINGMAN
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State | AZ
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Zip | 86409-0507
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Country | US
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Telephone | 928-757-8111
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Fax | 928-757-3256
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. DAWN D ABBOTT
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Credential | MA, LPC
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Telephone | 928-757-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | BH2398
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OTC5896
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License Number State | AZ
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