Organization Name: | PSA BEHAVIORAL HEALTH AGENCY |
NPI Number: | 1023222080 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SARA MARRIOTT (CEO PRESIDENT) |
Mailing Address: | 1243 E Broadway Rd Tempe |
State: | AZ US |
Postal Code: | 852821530 |
Phone Number: | 4808941568 |
Fax Number: | 4808945469 |
NPI Enumeration Date: | 05/09/2007 |
NPI Last Update Date: | 05/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | BH3028 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |