NPIMap

Organization Active NPI

Gentle Behavioral Health PLLC

  • Adult Mental Health Clinic/Center
  • Mesa, AZ
National Provider Identifier
1770058190
Registry record updated Oct 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
GENTLE BEHAVIORAL HEALTH PLLC
Practice address
1041 S Lebaron Ste P
Mesa, AZ 85210-3630
Phone
(480) 307-8809
Fax
(888) 972-7050
NPI assigned
Oct 11, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2018

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

Authorized official

Name
Lana Peterson, PMHNP
Title
Owner
Phone
(480) 307-8809

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

1041 S Lebaron Ste P
Mesa, AZ 85210-3630

Mailing address

1041 S Lebaron Ste P
Mesa, AZ 85210-3630
Phone (480) 307-8809

Other identifiers 1

IdentifierTypeStateIssuer
787757MedicaidAZ

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539302400000",
    "number": "1770058190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 S LEBARON STE P",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103630",
            "telephone_number": "480-307-8809",
            "fax_number": "888-972-7050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 S LEBARON STE P",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103630",
            "telephone_number": "480-307-8809",
            "fax_number": "888-972-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENTLE BEHAVIORAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-11",
        "last_updated": "2018-10-12",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "LANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-307-8809",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "787757",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 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.