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General NPI Number Information
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NPI Number | 1902993470
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 10-A WARD CANYON ROAD, ROOM 2
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City | CLIFTON
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State | AZ
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Zip | 85533
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Country | US
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Telephone | 928-865-4531
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Fax | 928-865-4821
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Provider Business Mailing Address
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Address Line | P.O BOX 2161 611 W. UNION STREET
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City | BENSON
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State | AZ
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Zip | 85602
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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 | CHIEF FINANCIAL OFFICER
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Name | MR. JOHN MOTOWSKI
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Credential | M.S.
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Telephone | 520-586-0800
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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 | BH2696
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License Number State | AZ
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