Immanuel Behavioral Health Counseling Clinic
Clinic/Center in Peoria, AZ. Organization (NPI-2).
NPI number1104495084
StatusActive
Last updated in NPPESApr 27, 2023
Details
- NPI
- 1104495084
- Entity type
- Organization (NPI-2)
- Legal business name
- Immanuel Behavioral Health Counseling Clinic
- Organization subpart
- Yes
- Enumeration date
- Jun 23, 2021
- Certification date
- Apr 27, 2023
- Last updated
- Apr 27, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Practice location
11301 N 99th Ave Ste 5120Peoria, AZ 85345-5485
Phone 623-876-6379 · Fax 623-876-6379
Mailing address
11301 N 99th Ave Ste 5120Peoria, AZ 85345-5485
Phone 623-876-6379 · Fax 623-876-6379
Authorized official
Brenda Kay Pierce
Chief Operating Officer
6237388549
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