Gibson Behavioral Health LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Glendale, AZ. Organization (NPI-2).
NPI number1104500909
StatusActive
Last updated in NPPESJun 12, 2023
Details
- NPI
- 1104500909
- Entity type
- Organization (NPI-2)
- Legal business name
- Gibson Behavioral Health LLC
- Organization subpart
- No
- Enumeration date
- Jun 12, 2023
- Certification date
- Jun 12, 2023
- Last updated
- Jun 12, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
4425 W Olive Ave Ste 203Glendale, AZ 85302-3853
Phone 312-599-8267
Mailing address
4425 W Olive Ave Ste 203Glendale, AZ 85302-3853
Authorized official
Lissa Sebatu
Ceo
3125998267
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