Organization
GIBSON LANE BEHAVIORAL HEALTH CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISSA SEBATU (OWNER)
(312) 599-8267
Entity
Organization
Contact information
Practice address
7725 N 43RD AVE BLDG 5, PHOENIX, AZ 85051-5770
(312) 599-8267
Mailing address
7725 N 43RD AVE BLDG 5, PHOENIX, AZ 85051-5770
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/19/2022
Last updated
04/19/2022
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