NPIMap

Organization Active NPI

Mohave Mental Health Clinic Inc

  • Clinic/Center
  • Lake Havasu City, AZ
National Provider Identifier
1316023864
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
OTC5973 Issued in AZ
Legal business name
MOHAVE MENTAL HEALTH CLINIC INC
Practice address
2187 Swanson Ave
Lake Havasu City, AZ 86403
Phone
(928) 855-3432
Fax
(928) 855-0103
NPI assigned
Oct 27, 2006
Last updated
Jun 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Authorized official

Name
Dawn D Abbott, MA, LPCNPI 1184612442
Title
Chief Executive Officer
Phone
(928) 757-8111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X BH645 AZ
Clinic/Center 261Q00000X OTC5973 AZ Primary

Addresses

Primary practice location

2187 Swanson Ave
Lake Havasu City, AZ 86403

Mailing address

3707 N Stockton Hill Rd Ste B
Kingman, AZ 86409-0507
Phone (928) 757-8111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422000707 AZ Part B Supplier - Clinic/Group Practice 7618963935 Receives reassigned benefits from 17 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bullhead City, AZ; Kingman, AZ; Lake Havasu City, AZ

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

1741 Sycamore Ave
Kingman, AZ 86409
Phone (928) 757-7872

1750 E Beverly Ave
Kingman, AZ 86409

3505 Western Ave
Ste A
Kingman, AZ 86409
Phone 9287578111 ext. 2322

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1316023864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 N STOCKTON HILL RD STE B",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864090507",
            "telephone_number": "928-757-8111",
            "fax_number": "928-757-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2187 SWANSON AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-855-3432",
            "fax_number": "928-855-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAVE MENTAL HEALTH CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "ABBOTT",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "928-757-8111",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AZ",
            "license": "BH645",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AZ",
            "license": "OTC5973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.