Provider Demographics
NPI:1225206444
Name:SAN TAN BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:SAN TAN BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:480-213-2293
Mailing Address - Street 1:240 N SUNWAY DR
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5034
Mailing Address - Country:US
Mailing Address - Phone:480-507-3644
Mailing Address - Fax:
Practice Address - Street 1:240 N SUNWAY DR
Practice Address - Street 2:SUITE 101B
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5034
Practice Address - Country:US
Practice Address - Phone:480-507-3644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3049251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health