Organization
TREATMENT ASSESSMENT SCREENING CENTER, INC
Active
Organization
TREATMENT ASSESSMENT SCREENING CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATRICE SHANNON HICKMAN DO (CHIEF PROGRAM OFFICER)
(602) 254-7328
Entity
Organization
Contact information
Practice address
2314 N 4TH ST, FLAGSTAFF, AZ 86004-3709
(928) 526-5417
(928) 526-5615
Mailing address
4016 N BLACK CANYON HWY, PHOENIX, AZ 85017-4730
(602) 254-7328
(602) 255-0851
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
OTC9085
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC9085
ARIZONA DEPARTMENT OF HEALTH SERVICES OUTPATIENT TREATMENT CENTER LICENSE
AZ
Enumeration date
08/23/2018
Last updated
08/23/2018
Update your record
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