Southeastern Arizona Behavioral Health Service, Inc.
Organization Active NPI Community/Behavioral Health Agency · Willcox, AZ
NPI 1790773620 · NPPES record last updated Sep 5, 2025
Key facts
- NPI
- 1790773620
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 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
- Organization subpart
- No
Authorized official
- Name
- Kathy Guzman Wells
- Title
- Evp/Coo
- Phone
- (520) 838-5501
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 5
Practitioners 1
-
Traci Richards Burks, NURSE PRACTITIONER
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Benson Outpatient Treatment Center
Locations
404 W Rex Allen Dr
Willcox, AZ 85643
Phone (520) 384-2521
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | BH-2672 | AZ | |
| Community/Behavioral Health Agency | 251S00000X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 082893 | Medicaid | AZ | |
| OTC-6143 | Other | AZ | ADHS LICENSING |
Other names
- SEABHS Willcox Outpatient
Other providers in Willcox, AZ
- Sherry'S Adult Care Homes,LLC
- Victoria Helene Singer
- Mekenna Smith
- Snook Chiropractic PLLC
- Diana Lynn Snook
- Southwestern Eye Center LTD
- Stephanie Daniel MD PLC
- William Straw
- Stronghold Emergency Physicians
- Sulphur Springs Medical Center
All providers in Willcox, AZ · Community/Behavioral Health Agency in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.