| Gibson Lane Behavioral Health Care Llc | |
|
7725 N 43rd Ave Bldg 5 Phoenix AZ 85051-5770 | |
| (312) 599-8267 | |
| Not Available |
| Full Name | Gibson Lane Behavioral Health Care Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 7725 N 43rd Ave Bldg 5, Phoenix, Arizona |
| Authorized Official Name and Position | Lissa Sebatu (OWNER) |
| Authorized Official Contact | 3125998267 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gibson Lane Behavioral Health Care Llc 7725 N 43rd Ave Bldg 5 Phoenix AZ 85051-5770 Ph: () - | Gibson Lane Behavioral Health Care Llc 7725 N 43rd Ave Bldg 5 Phoenix AZ 85051-5770 Ph: (312) 599-8267 |
| NPI Number | 1750024519 |
|---|---|
| Provider Enumeration Date | 04/19/2022 |
| Last Update Date | 04/19/2022 |
| Certification Date | 04/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750024519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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