NPIMap

Organization Active NPI

Mohave Mental Health Clinic, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Lake Havasu City, AZ
National Provider Identifier
1912458589
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
BH5021 Issued in AZ
Legal business name
MOHAVE MENTAL HEALTH CLINIC, INC.
Practice address
151 Riviera Dr Ste B
Lake Havasu City, AZ 86403-5740
Phone
(928) 855-3432
Fax
(928) 855-0103
NPI assigned
Oct 19, 2016
Last updated
Jun 23, 2021By the provider in NPPES
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, LPCNPI 1184612442
Title
Chief Executive Officer
Phone
(928) 757-8111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X BH5021 AZ Primary

Addresses

Primary practice location

151 Riviera Dr Ste B
Lake Havasu City, AZ 86403-5740

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
BH5021OtherAZADHS

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

915 Airway Ave
Kingman, AZ 86409
Phone (928) 718-4800

151 Riviera Dr
Ste B
Lake Havasu City, AZ 86403
Phone (928) 855-3432

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1912458589",
    "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",
            "fax_number": "928-757-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 RIVIERA DR STE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035740",
            "telephone_number": "928-855-3432",
            "fax_number": "928-855-0103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAVE MENTAL HEALTH CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "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": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "AZ",
            "license": "BH5021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS",
            "identifier": "BH5021",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, 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.