| Organization Name: | PSA BEHAVIORAL HEALTH AGENCY |
| NPI Number: | 1366864423 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY QUIROS (DIRECTOR OF I.T. & CLAIMS) |
| Mailing Address: | 1500 E 15th St Room 608 Douglas |
| State: | AZ US |
| Postal Code: | 856071731 |
| Phone Number: | 6029951767 |
| Fax Number: | |
| NPI Enumeration Date: | 01/09/2014 |
| NPI Last Update Date: | 01/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | OTC6116 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |