2nd Chance Behavioral Health Services LLC
Clinic/Center, Adult Mental Health in Glendale, AZ. Organization (NPI-2).
NPI number1053008870
StatusActive
Last updated in NPPESApr 21, 2023
Details
- NPI
- 1053008870
- Entity type
- Organization (NPI-2)
- Legal business name
- 2nd Chance Behavioral Health Services LLC
- Organization subpart
- No
- Enumeration date
- Apr 21, 2023
- Certification date
- Apr 19, 2023
- Last updated
- Apr 21, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | |
| 101YM0800X | Counselor, Mental Health | – | – | |
| 101YP2500X | Counselor, Professional | – | – | |
| 106S00000X | Behavior Technician | – | – | |
| 171M00000X | Case Manager/Care Coordinator | – | – |
Practice location
10620 N 43rd Ave Ste 10Glendale, AZ 85304-4150
Phone 602-860-0044 · Fax 602-848-3186
Mailing address
10620 N 43rd Ave Ste 10Glendale, AZ 85304-4150
Phone 602-860-0044 · Fax 602-848-3186
Authorized official
Domity Akoi
Administrator
6028600044
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