Organization
PTL BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN KISSI LAUDER SR. (ADMINISTRATOR)
(480) 516-9075
Entity
Organization
Contact information
Practice address
10839 E SONRISA AVE, MESA, AZ 85212-5126
(480) 485-6075
(480) 485-6865
Mailing address
10839 E SONRISA AVE, MESA, AZ 85212-5126
(480) 485-6075
(480) 485-6865
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/31/2017
Last updated
07/21/2022
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