Basic Information
| Provider Information | |||||||||
| NPI: | 1306265285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLAND BEHAVIORAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4530 E MUIRWOOD DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806106981 | ||||||||
| FaxNumber: | 4808987419 | ||||||||
| Practice Location | |||||||||
| Address1: | 4530 E MUIRWOOD DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806106981 | ||||||||
| FaxNumber: | 4808987419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2014 | ||||||||
| LastUpdateDate: | 04/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | DAVEY | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4804550987 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.