NPIMap

Organization Active NPI

Mohave Mental Health Clinic Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Kingman, AZ
National Provider Identifier
1831756659
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
MOHAVE MENTAL HEALTH CLINIC INC
Practice address
1743 Sycamore Ave
Kingman, AZ 86409-0927
Phone
(928) 757-8111
NPI assigned
May 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Authorized official

Name
Dawn D Abbott, MA, LPC
Title
Chief Executive Officer
Phone
(928) 757-8111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

1743 Sycamore Ave
Kingman, AZ 86409-0927

Mailing address

3707 N Stockton Hill Rd Ste B
Kingman, AZ 86409-0507
Phone (928) 757-8111

Other identifiers 1

IdentifierTypeStateIssuer
BH5704OtherAZARIZONA DEPARTMENT OF HEALTH SERVICES

Other names 1

  • Sycamore House Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jrettman@mmhc-inc.org Direct Mohave Mental Health Clinic Inc

National Provider Directory

National Provider Directory
Tax ID family
Mohave Mental Health CL8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

3707 N Stockton Hill Rd
Ste B
Kingman, AZ 86409

NPI Registry JSON

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

{
    "created_epoch": "1559001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1831756659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 N STOCKTON HILL RD STE B",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864090507",
            "telephone_number": "928-757-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1743 SYCAMORE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864090927",
            "telephone_number": "928-757-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAVE MENTAL HEALTH CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-28",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "ABBOTT",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "928-757-8111",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA DEPARTMENT OF HEALTH SERVICES",
            "identifier": "BH5704",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jrettman@mmhc-inc.org",
            "affiliation": "Y",
            "affiliationName": "Mohave Mental Health Clinic Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3707 N Stockton Hill Rd Ste B",
            "city": "Kingman",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "864090507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sycamore House",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sycamore House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.