| Little Colorado Behavioral Health Center Inc. | |
|
470 W Cleveland St Saint Johns AZ 85936-4501 | |
| (928) 337-4301 | |
| (928) 337-2269 |
| Full Name | Little Colorado Behavioral Health Center Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 470 W Cleveland St, Saint Johns, Arizona |
| Authorized Official Name and Position | John Hogeboom (CEO) |
| Authorized Official Contact | 4808317566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Little Colorado Behavioral Health Center Inc. Po Box 579 Saint Johns AZ 85936-0579 Ph: (928) 337-4301 | Little Colorado Behavioral Health Center Inc. 470 W Cleveland St Saint Johns AZ 85936-4501 Ph: (928) 337-4301 |
| NPI Number | 1134292485 |
|---|---|
| Provider Enumeration Date | 11/16/2006 |
| Last Update Date | 09/18/2024 |
| Certification Date | 09/18/2024 |
| Medicare PECOS PAC ID | 4587657465 |
|---|---|
| Medicare Enrollment ID | O20040406001303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134292485 | NPI | - | NPPES |
| 003442 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Alisha K Holben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003516006 PECOS PAC ID: 8729447933 Enrollment ID: I20230706002649 |
| Provider Name | Rodney S Poche |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1649334897 PECOS PAC ID: 3678717154 Enrollment ID: I20240105003687 |
| Provider Name | Paul D Otto |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1437213659 PECOS PAC ID: 9032560891 Enrollment ID: I20240105003756 |
| Provider Name | Daisy M Morales |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669083473 PECOS PAC ID: 9133570724 Enrollment ID: I20240108005609 |
Community Awareness Resource Entity Of Arizona Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 160 E Commercial, Saint Johns, AZ 85936 Phone: 928-337-4000 |