Provider Demographics
NPI:1538958970
Name:CROWN BEHAVIORAL INTEGRATED CLINIC
Entity type:Organization
Organization Name:CROWN BEHAVIORAL INTEGRATED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MBARUSHIMANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-312-1334
Mailing Address - Street 1:6619 N 19TH AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1631
Mailing Address - Country:US
Mailing Address - Phone:480-214-5886
Mailing Address - Fax:
Practice Address - Street 1:6619 N 19TH AVE STE C1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1631
Practice Address - Country:US
Practice Address - Phone:480-214-5886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty