Organization
BANNER PSYCHOLOGICAL SERVICES
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS E DAHLEN (SR VICE PRESIDENT FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1920 N HIGLEY RD, SUITE 106, GILBERT, AZ 85234-1623
(480) 543-2688
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
BH-3057
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279741
—
AZ
Enumeration date
10/29/2007
Last updated
12/08/2011
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