NPIMap

Organization Active NPI

South Eastern Arizona Behavioral Health Services, Inc.

  • Community/Behavioral Health Agency
  • Douglas, AZ
National Provider Identifier
1578033809
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SOUTH EASTERN ARIZONA BEHAVIORAL HEALTH SERVICES, INC.
Practice address
1100 N F Ave
Douglas, AZ 85607-1919
Phone
(520) 364-3630
Fax
(520) 586-6104
NPI assigned
Nov 29, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Authorized official

Name
Estella Hernandez, MBA
Title
Contracts & Credentialing Admin
Phone
(520) 838-5513

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1100 N F Ave
Douglas, AZ 85607-1919

Mailing address

611 W Union St
Benson, AZ 85602-6718
Phone (520) 586-0800

Other identifiers 2

IdentifierTypeStateIssuer
478436MedicaidAZ
OTC-9263OtherAZADHS LICENSING

Other names 1

  • Douglas Integrated Counseling Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Benson Outpatient Treatment Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1578033809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W UNION ST",
            "city": "BENSON",
            "state": "AZ",
            "postal_code": "856026718",
            "telephone_number": "520-586-0800",
            "fax_number": "520-586-0855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N F AVE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071919",
            "telephone_number": "520-364-3630",
            "fax_number": "520-586-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH EASTERN ARIZONA BEHAVIORAL HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-29",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "ESTELLA",
        "authorized_official_title_or_position": "CONTRACTS & CREDENTIALING ADMIN",
        "authorized_official_telephone_number": "520-838-5513",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "478436",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS LICENSING",
            "identifier": "OTC-9263",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Douglas Integrated Counseling Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Douglas Integrated Counseling Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglas, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; 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.