Active Integrated Health

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

ACTIVE INTEGRATED HEALTH

Practice address

12402 W Soledad St
El Mirage, AZ 85335-7244

Phone

(623) 262-8239

NPI assigned

Sep 17, 2021

Last updated

Sep 17, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bryce Bellue

Title

Part Owner

Phone

(623) 505-8198

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1366112609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12402 W SOLEDAD ST",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853357244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12402 W SOLEDAD ST",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853357244",
            "telephone_number": "623-262-8239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13307 W Gelding Dr",
            "address_purpose": "LOCATION",
            "city": "Surprise",
            "state": "AZ",
            "postal_code": "853796488",
            "country_code": "US",
            "telephone_number": "623-505-8198",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13007 N 55th Dr",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853041224",
            "country_code": "US",
            "telephone_number": "623-313-3206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ACTIVE INTEGRATED HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "BELLUE",
        "authorized_official_first_name": "BRYCE",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "623-505-8198",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in El Mirage, AZ
• Providers in El Mirage, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.