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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