NPIMap

Organization Active NPI

Southeastern Arizona Behavioral Health Service, Inc.

  • Community/Behavioral Health Agency
  • Willcox, AZ
National Provider Identifier
1790773620
Registry record updated Sep 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICE, INC.
Practice address
404 W Rex Allen Dr
Willcox, AZ 85643-1120
Phone
(520) 384-2521
Fax
(520) 384-0543
NPI assigned
Oct 13, 2005
Last updated
Sep 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2025

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

Authorized official

Name
Kathy Guzman Wells
Title
Evp/Coo
Phone
(520) 838-5501

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X BH-2672 AZ
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

404 W Rex Allen Dr
Willcox, AZ 85643-1120

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
082893MedicaidAZ
OTC-6143OtherAZADHS LICENSING

Other names 1

  • SEABHS Willcox Outpatient Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421000934 AZ Part B Supplier - Clinic/Group Practice 2860488368 Receives reassigned benefits from 19 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sierra Vista, AZ; Willcox, AZ; Safford, AZ; Benson, AZ

Other NPIs on the same Medicare enrollment 6

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

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.

Locations

404 W Rex Allen Dr
Willcox, AZ 85643
Phone (520) 384-2521

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757030400000",
    "number": "1790773620",
    "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": "520-586-0116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W REX ALLEN DR",
            "city": "WILLCOX",
            "state": "AZ",
            "postal_code": "856431120",
            "telephone_number": "520-384-2521",
            "fax_number": "520-384-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "GUZMAN",
        "authorized_official_title_or_position": "EVP/COO",
        "authorized_official_telephone_number": "520-838-5501"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "AZ",
            "license": "BH-2672",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "082893",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS LICENSING",
            "identifier": "OTC-6143",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SEABHS Willcox Outpatient",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SEABHS Willcox Outpatient",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Willcox, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2025; 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.