Organization · NPI-2

Samaria Behavioral Health Center LLC

Nurse Practitioner, Psych/Mental Health · Tempe, AZ

NPI number1861099798

StatusActive

Last updated in NPPESDec 13, 2024

Details

NPI: 1861099798
Entity type: Organization (NPI-2)
Legal business name: Samaria Behavioral Health Center LLC
Organization subpart: No
Enumeration date: Oct 5, 2020
Certification date: Dec 13, 2024
Last updated: Dec 13, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LP0808X	Nurse Practitioner, Psych/Mental Health	–	–	Yes
106S00000X	Behavior Technician	–	–
175T00000X	Peer Specialist	–	–
251B00000X	Case Management	–	–
251S00000X	Community/Behavioral Health	–	–
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–
363LF0000X	Nurse Practitioner, Family	–	–
367500000X	Nurse Anesthetist, Certified Registered	–	–

Practice location

6197 S Rural Rd
Tempe, AZ 85283-2909

Phone 480-471-8980 · Fax 480-912-1061

Mailing address

6197 S Rural Rd
Tempe, AZ 85283-2909

Phone 480-471-8980 · Fax 480-912-1061

Authorized official

Benitho Louissaint
Member
4804718980

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