Organization
SOUTH EASTERN ARIZONA BEHAVIORAL HEALTH SERVICES, INC.
Active
Other names
Douglas Integrated Counseling Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ESTELLA HERNANDEZ MBA (CONTRACTS & CREDENTIALING ADMIN)
(520) 838-5513
Entity
Organization
Contact information
Practice address
1100 N F AVE, DOUGLAS, AZ 85607-1919
(520) 364-3630
(520) 586-6104
Mailing address
611 W UNION ST, BENSON, AZ 85602-6718
(520) 586-0800
(520) 586-0855
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
478436
—
AZ
01
—
OTC-9263
ADHS LICENSING
AZ
Enumeration date
11/29/2018
Last updated
06/10/2022
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