MEDICARE: SOUTHWEST BEHAVIORAL HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	BH-3583	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH-3583	OTHER	AZ	ARIZONA DEPT OF HEALTH SERVICES, OBHL

General Provider Information

NPI Number	:	1851610117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST BEHAVIORAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	3450 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 HUALAPAI MOUNTAIN RD SUITES E, H & I
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-8324
Country	:	US
Telephone Number	:	928-753-9387
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	STEVEN SHEETS
Credential	:
Telephone Number	:	26-351-6904

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	09/01/2023

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