Passport to Behavioral Health LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PASSPORT TO BEHAVIORAL HEALTH LLC

Practice address

3162 W Hayden Peak Dr
Queen Creek, AZ 85142-6092

Phone

(702) 479-8400

NPI assigned

Sep 4, 2019

Organization subpart

No

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

Authorized official

Name

Denise S Coles

Title

Onwer

Phone

(702) 479-8400

Specialties & licenses 1

Addresses

Other names 1

• Passport to Behavioral Health LLC Former legal business name

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

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567555200000",
    "number": "1982253894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3162 W HAYDEN PEAK DR",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851426092",
            "telephone_number": "702-479-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3162 W HAYDEN PEAK DR",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851426092",
            "telephone_number": "702-479-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT TO BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-04",
        "last_updated": "2019-09-04",
        "status": "A",
        "authorized_official_last_name": "COLES",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ONWER",
        "authorized_official_telephone_number": "702-479-8400"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passport to Behavioral Health LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Anna Panosian, RN, IBCLC
• Stephen Panosian, FNP
• Clairissa Patricia Papa, D.M.D.
• Gilbert Cerezo Pascual Jr., RNFA
• Anna Louise Pasquinelli, COTA
• Jaclyn Pastena, OTR/L
• Pinal Patel, LCSW
• Peace of Mind365
• Peach Tree Dental Group, LLP
• Peak Solutions Counseling, LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; 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.