Provider Demographics
NPI:1366941361
Name:PARAMOUNT BEHAVIORAL HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:PARAMOUNT BEHAVIORAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLOU
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:623-225-6220
Mailing Address - Street 1:PO BOX 10727
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0727
Mailing Address - Country:US
Mailing Address - Phone:623-225-6220
Mailing Address - Fax:623-518-2349
Practice Address - Street 1:1631 W BURNSIDE TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8071
Practice Address - Country:US
Practice Address - Phone:623-225-6220
Practice Address - Fax:623-518-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4900363A00000X
AZ456612084P0800X, 2084P0800X
AZ5902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty