| Southeastern Arizona Behavioral Health Services, Inc. | |
|
611 W Union St Benson AZ 85602-6718 | |
| (520) 586-6177 | |
| Not Available |
| Full Name | Southeastern Arizona Behavioral Health Services, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 611 W Union St, Benson, Arizona |
| Authorized Official Name and Position | Estella Hernandez (CONTRACTS & CREDENTIALING ADMIN) |
| Authorized Official Contact | 5208385513 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Arizona Behavioral Health Services, Inc. 611 W Union St Benson AZ 85602-6718 Ph: () - | Southeastern Arizona Behavioral Health Services, Inc. 611 W Union St Benson AZ 85602-6718 Ph: (520) 586-6177 |
| NPI Number | 1760830137 |
|---|---|
| Provider Enumeration Date | 05/26/2016 |
| Last Update Date | 06/08/2022 |
| Certification Date | 06/08/2022 |
| Medicare PECOS PAC ID | 2860488368 |
|---|---|
| Medicare Enrollment ID | O20040421000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760830137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH4804 (Arizona) | Primary |
| Provider Name | John K Ekman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194722256 PECOS PAC ID: 4183695281 Enrollment ID: I20040803000744 |
| Provider Name | Vinod B Patel |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1821054503 PECOS PAC ID: 9234103235 Enrollment ID: I20040825000249 |
| Provider Name | Debra L Ford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376618033 PECOS PAC ID: 1658367040 Enrollment ID: I20050322000778 |
| Provider Name | Dmitry V Listengarten |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669433173 PECOS PAC ID: 4486680931 Enrollment ID: I20050715000218 |
| Provider Name | Mohamed I Ramadan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225025984 PECOS PAC ID: 4183657034 Enrollment ID: I20050913000165 |
| Provider Name | Jane Ackerley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588868921 PECOS PAC ID: 4880761055 Enrollment ID: I20080930000596 |
| Provider Name | Chad Rubin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548256142 PECOS PAC ID: 5597822288 Enrollment ID: I20090325000128 |
| Provider Name | Constance L Slay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396919346 PECOS PAC ID: 5294882940 Enrollment ID: I20090415000203 |
| Provider Name | Mary K Fuller-fougerousse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336479906 PECOS PAC ID: 9830232487 Enrollment ID: I20100204000088 |
| Provider Name | Mary J Maymana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457558868 PECOS PAC ID: 3577759885 Enrollment ID: I20101129001059 |
| Provider Name | Eric A Hegybeli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487879342 PECOS PAC ID: 2668658527 Enrollment ID: I20110511000269 |
| Provider Name | Steven M Diez De Pinos |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063502201 PECOS PAC ID: 2264699925 Enrollment ID: I20120208000066 |
| Provider Name | Linda M Banziger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467695726 PECOS PAC ID: 6800925371 Enrollment ID: I20120302000660 |
| Provider Name | William Adamas-rappaport |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134213762 PECOS PAC ID: 3577722313 Enrollment ID: I20120314000140 |
| Provider Name | Daniel D Hammond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518116839 PECOS PAC ID: 2961541495 Enrollment ID: I20140820000525 |
| Provider Name | Dorothy Deette Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497883169 PECOS PAC ID: 4587757042 Enrollment ID: I20140903001953 |
| Provider Name | Maryam H Lateef |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477533610 PECOS PAC ID: 3577475888 Enrollment ID: I20141023000369 |
| Provider Name | Nirva Jean-baptiste |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407279771 PECOS PAC ID: 3577887553 Enrollment ID: I20150122000480 |
| Provider Name | Catherine M Etori |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255722633 PECOS PAC ID: 6103145974 Enrollment ID: I20151106000597 |
| Provider Name | Karen Shelton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164836565 PECOS PAC ID: 3375843360 Enrollment ID: I20151123002666 |
| Provider Name | Rodric D Falcon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063785350 PECOS PAC ID: 9234367400 Enrollment ID: I20160323001111 |
| Provider Name | Sarah Manco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396907598 PECOS PAC ID: 3678736238 Enrollment ID: I20160429000909 |
| Provider Name | Brett Lee Wadsworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649727249 PECOS PAC ID: 6709168743 Enrollment ID: I20170126001961 |
| Provider Name | Kelleen Stiles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437468840 PECOS PAC ID: 9638453160 Enrollment ID: I20170301002060 |
| Provider Name | Michael D Worley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548704125 PECOS PAC ID: 4880962687 Enrollment ID: I20170620002766 |
| Provider Name | Debra A Ort |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396805412 PECOS PAC ID: 7618925298 Enrollment ID: I20170907001782 |
| Provider Name | Sonia J Shoup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861672081 PECOS PAC ID: 8527286210 Enrollment ID: I20171003007562 |
| Provider Name | Erkan Caygoz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356868160 PECOS PAC ID: 0547528218 Enrollment ID: I20171229002261 |
| Provider Name | Jillian Eve Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134614324 PECOS PAC ID: 8820347685 Enrollment ID: I20180828001372 |
| Provider Name | Tolulope A Dada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124418728 PECOS PAC ID: 0143548586 Enrollment ID: I20181015000551 |
| Provider Name | Tera K Waldroup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710250055 PECOS PAC ID: 7719204320 Enrollment ID: I20181016001341 |
| Provider Name | Marie A Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619219375 PECOS PAC ID: 2668613811 Enrollment ID: I20181105002586 |
| Provider Name | Jennifer L Neiss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518588763 PECOS PAC ID: 5991126609 Enrollment ID: I20200605000292 |
| Provider Name | Anton Dragonetti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972091221 PECOS PAC ID: 8224393640 Enrollment ID: I20210909003132 |
| Provider Name | Traci Richards Burks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528171899 PECOS PAC ID: 7012310063 Enrollment ID: I20220120002473 |
| Provider Name | Daniel J Arteago |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235563909 PECOS PAC ID: 3274929260 Enrollment ID: I20220330002087 |
| Provider Name | Patricia Hoffman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114994050 PECOS PAC ID: 9335583624 Enrollment ID: I20240214002478 |
| Provider Name | Sandra B Kalnins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710954573 PECOS PAC ID: 3577564996 Enrollment ID: I20240418002188 |
| Provider Name | Emmanuel E Mbi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528703261 PECOS PAC ID: 9436529831 Enrollment ID: I20240605002998 |
| Provider Name | Kendra A Bowles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326781808 PECOS PAC ID: 4486034527 Enrollment ID: I20250305003957 |
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