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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

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Active Organization

Community/Behavioral Health · PHOENIX, AZ

Registration Details

NPI Number
1104856004
Provider Type
Organization
NPI Issued
Jul 4, 2006 (19.799526605621 yrs)
Last Updated
Jan 29, 2026
Licenses
OTC6258 (AZ)
OTC6258 (AZ)

Practice Information

Address
120 N 44TH ST STE 400
PHOENIX, AZ, 850341822
Browse AZ providers · Browse ZIP 85034
Phone
6023040014
Fax
6023040190
Primary Specialty
Community/Behavioral Health
251S00000X
Additional Specialty
Community/Behavioral Health

Other Community/Behavioral Health Organizations in PHOENIX, AZ

Data sourced from the NPPES National Provider Identifier registry. Healthcare organizations registered in NPPES are assigned an NPI number for use in insurance billing and claims. This information is for informational purposes only. For official verification, use the NPPES NPI Registry.