Provider Demographics
NPI:1528796596
Name:AGAVE CENTER FOR BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:AGAVE CENTER FOR BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELI
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:480-826-3537
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE C105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3067
Mailing Address - Country:US
Mailing Address - Phone:480-826-3537
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE C105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3067
Practice Address - Country:US
Practice Address - Phone:480-826-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty