| Agave Center For Behavioral Health Pllc | |
|
1930 S Alma School Rd Ste C105 Mesa AZ 85210-3067 | |
| (480) 826-3537 | |
| Not Available |
| Full Name | Agave Center For Behavioral Health Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1930 S Alma School Rd Ste C105, Mesa, Arizona |
| Authorized Official Name and Position | Sheli Jensen (OWNER) |
| Authorized Official Contact | 4808263537 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Agave Center For Behavioral Health Pllc 1930 S Alma School Rd Ste C105 Mesa AZ 85210-3067 Ph: (480) 826-3537 | Agave Center For Behavioral Health Pllc 1930 S Alma School Rd Ste C105 Mesa AZ 85210-3067 Ph: (480) 826-3537 |
| NPI Number | 1528796596 |
|---|---|
| Provider Enumeration Date | 08/09/2022 |
| Last Update Date | 03/15/2024 |
| Certification Date | 03/15/2024 |
| Medicare PECOS PAC ID | 7618318858 |
|---|---|
| Medicare Enrollment ID | O20240517003748 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528796596 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Sheli K Jensen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1982155503 PECOS PAC ID: 8527409762 Enrollment ID: I20240517003755 |
| Provider Name | Shawna Hale |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497496871 PECOS PAC ID: 1355883547 Enrollment ID: I20240603003304 |
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