Provider Demographics
NPI:1124486469
Name:STRATUM MENTAL HEALTH OF ARIZONA INC
Entity type:Organization
Organization Name:STRATUM MENTAL HEALTH OF ARIZONA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:GREYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-578-7288
Mailing Address - Street 1:40335 WINCHESTER RD # E221
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5500
Mailing Address - Country:US
Mailing Address - Phone:855-578-7288
Mailing Address - Fax:888-741-7967
Practice Address - Street 1:3104 E CAMELBACK RD
Practice Address - Street 2:#2031
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4502
Practice Address - Country:US
Practice Address - Phone:855-578-7288
Practice Address - Fax:888-741-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty