MOHAVE MENTAL HEALTH CLINIC, INC. (NPI# 1912458589) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912458589 |
| Entity Type | Organization |
| Organization Name | MOHAVE MENTAL HEALTH CLINIC, INC. |
| Practice Address |
151 Riviera Dr Ste B Lake Havasu City AZ 86403-5740 |
| Mailing Address |
1743 Sycamore Ave Kingman AZ 86409-0927 |
| Practice Telephone | 9288553432 |
| Practice Fax Number | 9288550103 |
| Mailing Telephone | 9287578111 |
| Mailing Fax Number | 9287573256 |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |
| Authorized Official Name | DAWN D ABBOTT (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9287578111 |
| Authorized Official Credential | MA, LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
BH5021 | AZ | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | ADHS | BH5021 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689195901 | Mohave Mental Health Clinic, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3745 N Diamond Dr, Kingman, AZ 86409-3328 | 2017-06-28 |
| 1619294865 | Mohave Mental Health Clinic, Inc. | Clinic/Center | 2580 Highway 95, Suite 209, Bullhead City, AZ 86442-7491 | 2010-04-28 |
| Street Address |
151 RIVIERA DR STE B |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-5740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962730309 | Arizona's Children Association | Clinic/Center | 1407 Mcculloch Blvd N, Lake Havasu City, AZ 86403-6513 | 2009-11-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538778899 | Star House Bhrf LLC | Clinic/Center | 44796 W Sandhill Road, Maricopa, AZ 85139 | 2020-07-23 |
| 1508480377 | Muhammad Azeem Butt | Clinic/Center | 44796 W Sandhill Rd, Maricopa, AZ 85139-9113 | 2020-06-07 |
| 1598394850 | Rite of Passage Inc | Clinic/Center | 20275 E Rittenhouse Rd Ste 105, Queen Creek, AZ 85142-4534 | 2020-04-07 |
| 1417593575 | Obsidian Health and Wellness LLC | Clinic/Center | 13321 W Indian School Rd Ste A107, Litchfield Park, AZ 85340-4339 | 2019-11-25 |
| 1285289736 | Ericka Catrise Barker | Clinic/Center | 12858 W Alvarado Rd, Avondale, AZ 85392-7144 | 2019-08-01 |
| 1003469057 | East Valley Child Psychology | Clinic/Center | 1910 S Stapley Dr Ste 221, Mesa, AZ 85204-6680 | 2019-07-18 |
| 1851874036 | Arizonas New Hope | Clinic/Center | 5045 W Baseline Rd Ste A105-214, Laveen, AZ 85339-7392 | 2018-09-13 |
| 1316437502 | Arizona's Children Association | Clinic/Center | 1345 E Main St Ste 104, Mesa, AZ 85203 | 2018-05-14 |
| 1760972947 | Arizona's Children Association | Clinic/Center | 1420 N Greenfield Rd Ste 100&101, Gilbert, AZ 85234 | 2018-05-14 |
| 1609305564 | The Highway: A Self-harm and Suicide Prevention Service | Clinic/Center | 7572 E Buena Vista Dr, Prescott Valley, AZ 86314-5563 | 2017-06-05 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.