Organization Name: | PSA BEHAVIORAL HEALTH AGENCY |
NPI Number: | 1457609406 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIMBERLY QUIROS (DIRECTOR OF IT & CLAIMS) |
Mailing Address: | 8027 N Black Canyon Hwy Suite 2 Phoenix |
State: | AZ US |
Postal Code: | 850214802 |
Phone Number: | 6029951767 |
Fax Number: | |
NPI Enumeration Date: | 08/23/2012 |
NPI Last Update Date: | 02/14/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | BH-4068 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |