1699910877 NPI number — BEHAVIORAL CONSULTATION SERVICES OF NORTHERN ARIZONA

Table of content: MR. MICHAEL SHANNON DIPRIMO ARNP (NPI 1063912848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699910877 NPI number — BEHAVIORAL CONSULTATION SERVICES OF NORTHERN ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL CONSULTATION SERVICES OF NORTHERN ARIZONA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699910877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 W UNIVERSITY AVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001-2986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-522-3780
Provider Business Mailing Address Fax Number:
928-526-2119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
906 W UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-2986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-522-3780
Provider Business Practice Location Address Fax Number:
928-526-2119
Provider Enumeration Date:
12/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF SERVICES
Authorized Official Telephone Number:
928-522-3780

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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