NPIMap

Organization Active NPI

TBM Mental Health LLC

  • Mental Health Counselor
  • Glendale, AZ
National Provider Identifier
1093167108
Registry record updated Jul 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
RN1348 Issued in AZ
Legal business name
TBM MENTAL HEALTH LLC
Practice address
17431 N 71St Dr
Suite 104
Glendale, AZ 85308-8598
Phone
(480) 521-6586
NPI assigned
Jul 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Timothy MillerNPI 1700866852
Title
MBR
Phone
(480) 521-6586

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X RN1348 AZ Primary

Addresses

Primary practice location

17431 N 71St Dr
Suite 104
Glendale, AZ 85308-8598

Mailing address

17431 N 71St Dr
Suite 104
Glendale, AZ 85308-8598
Phone (480) 521-6586

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170120002786 AZ Part B Supplier - Clinic/Group Practice 0345522637 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Glendale, AZ; Litchfield Park, AZ

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
TBM Mental Health LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

17431 N 71st Dr
Ste 104
Glendale, AZ 85308
Phone (623) 776-9111

17431 N 71st Dr
Ste 103
Glendale, AZ 85308
Phone (480) 521-6586

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1093167108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17431 N 71ST DR",
            "address_2": "SUITE 104",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088598",
            "telephone_number": "480-521-6586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17431 N 71ST DR",
            "address_2": "SUITE 104",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088598",
            "telephone_number": "480-521-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TBM MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-13",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "480-521-6586"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "RN1348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.