MEDICARE: THINK PSYCHOLOGICAL AND CONSULTING SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1720591365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THINK PSYCHOLOGICAL AND CONSULTING SERVICES PLLC

Provider Business Mailing Address
First Line	:	2632 S 83RD AVE STE 100-481
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-7206
Country	:	US
Telephone Number	:	480-584-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 S 83RD AVE STE 100-481
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-7206
Country	:	US
Telephone Number	:	480-584-9242
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMILAH LOGAN
Credential	:
Telephone Number	:	480-584-9242

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	11/06/2017

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