Organization
INTEGRATED BEHAVIORAL CARE & WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL KENTA-BIBI (OWNER)
(860) 518-1389
Entity
Organization
Contact information
Practice address
2266 S DOBSON RD STE 200, MESA, AZ 85202-6412
(860) 518-1389
Mailing address
2266 S DOBSON RD STE 200, MESA, AZ 85202-6412
(860) 518-1389
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC12102
AZDHS
AZ
Enumeration date
12/14/2022
Last updated
12/14/2022
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