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
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