Provider Demographics
NPI:1548868797
Name:SENTINEL BEHAVIORAL CONSULTING
Entity type:Organization
Organization Name:SENTINEL BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAAKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELZY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:520-440-7435
Mailing Address - Street 1:2915 N EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5509
Mailing Address - Country:US
Mailing Address - Phone:520-440-7435
Mailing Address - Fax:
Practice Address - Street 1:2915 N EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5509
Practice Address - Country:US
Practice Address - Phone:520-440-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ253498Medicaid