| Organization Name: | PSA BEHAVIORAL HEALTH AGENCY |
| NPI Number: | 1215362082 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY QUIROS (DIRECTOR OF IT & CLAIMS) |
| Mailing Address: | 1326 W Highway 92 Suite K Bisbee |
| State: | AZ US |
| Postal Code: | 856031151 |
| Phone Number: | 5204323980 |
| Fax Number: | |
| NPI Enumeration Date: | 09/11/2013 |
| NPI Last Update Date: | 09/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | BH-4309 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |