NPIMap

Organization Active NPI

San Tan Behavioral Health Services

  • Child Mental Illness Respite Care
  • Gilbert, AZ
National Provider Identifier
1770052292
Registry record updated Nov 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Mental Illness Respite CareTaxonomy code 385HR2055X
Legal business name
SAN TAN BEHAVIORAL HEALTH SERVICES
Practice address
3970 East Juanita Avenue
Gilbert, AZ 85234
Phone
(480) 507-3644
Fax
(480) 632-0026
NPI assigned
Nov 14, 2018
Organization subpart
Yes
Parent organization
SAN TAN BEHAVIORAL HEALTH LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2018

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

Authorized official

Name
Mrs. Melissa Dawn Nelson, MA, LPCNPI 1720489354
Title
Owner
Phone
(480) 507-3644

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
Child Mental Illness Respite Care 385HR2055X Primary

Addresses

Primary practice location

3970 East Juanita Avenue
Gilbert, AZ 85234

Mailing address

459 N. Gilbert Rd Ste C-100
Gilbert, AZ 85234
Phone (840) 507-3644

Other identifiers 1

IdentifierTypeStateIssuer
308968MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
San Tan Behavioral Health SVCS7 organizations share this tax ID, including this one
Part of
San Tan Behavioral Health SVCS

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542153600000",
    "number": "1770052292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "459 N. GILBERT RD STE C-100",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "840-507-3644",
            "fax_number": "480-632-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3970 EAST JUANITA AVENUE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "85234",
            "telephone_number": "480-507-3644",
            "fax_number": "480-632-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN TAN BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN TAN BEHAVIORAL HEALTH LLC",
        "enumeration_date": "2018-11-14",
        "last_updated": "2018-11-14",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-507-3644",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "308968",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; 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.