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Organization
SAN TAN BEHAVIORAL HEALTH SERVICES
Active
Organization
SAN TAN BEHAVIORAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA DAWN NELSON M.A., L.P.C. (CHIEF CLINICAL OFFICER)
(480) 507-3644
Entity
Organization
Contact information
Practice address
655 SOUTHLAKE RD, LAKESIDE, AZ 85929-6768
(928) 358-1087
(480) 632-0026
Mailing address
2451 E BASELINE RD, GILBERT, AZ 85234-2471
(480) 507-3644
(480) 632-0026
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
BH3755
AZ
385HR2055X
Child Mental Illness Respite Care
Primary
BH3755
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
308968
AHCCCS
AZ
Enumeration date
12/01/2010
Last updated
12/01/2010
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