Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mogollon Treatment Center

Organization Substance Abuse Rehabilitation Facility · NPI 1578482402

Mogollon Treatment Center is a Substance Abuse Rehabilitation Facility in Phoenix, Arizona. Registered with an NPI since 2026.

In the registry since
2026

Practice location Address checks out

9417 N 17th Pl
Phoenix, AZ 85020-2310
Phone: (928) 466-4242
Fax: (928) 474-7460
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Substance Abuse Rehabilitation Facility (primary) Taxonomy 324500000X

Record details

NPI number1578482402
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Dustin Bullard — Owner · (928) 466-4242
NPI enumeratedJuly 14, 2026
Last updated in NPPESJuly 14, 2026
Certification dateJuly 14, 2026
Mailing address306 W Aero Dr, Payson, AZ 85541-5405

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