Provider Demographics
NPI:1104455476
Name:PHOENIX BEHAVIORAL GROUP LLC
Entity type:Organization
Organization Name:PHOENIX BEHAVIORAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YESICA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-334-4515
Mailing Address - Street 1:830 E SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3009
Mailing Address - Country:US
Mailing Address - Phone:702-334-4515
Mailing Address - Fax:702-441-1966
Practice Address - Street 1:830 E SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3009
Practice Address - Country:US
Practice Address - Phone:702-334-4515
Practice Address - Fax:702-441-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health