Provider Demographics
NPI:1194328450
Name:COCONINO COUNTY JUVENILE COURTS
Entity type:Organization
Organization Name:COCONINO COUNTY JUVENILE COURTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COURT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-226-5414
Mailing Address - Street 1:1001 E. SAWMILL RD.
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5833
Mailing Address - Country:US
Mailing Address - Phone:928-226-5409
Mailing Address - Fax:928-226-5454
Practice Address - Street 1:1001 E. SAWMILL RD.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5833
Practice Address - Country:US
Practice Address - Phone:928-226-5409
Practice Address - Fax:928-226-5454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COCONINO COUNTY JUVENILE COURTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty