Healthcare Provider Details

I. General information

NPI: 1861306409
Provider Name (Legal Business Name): NEUROBRIDGE DIAGNOSTIC AND BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13615 W CATALINA DR
AVONDALE AZ
85392-3556
US

IV. Provider business mailing address

13615 W CATALINA DR
AVONDALE AZ
85392-3556
US

V. Phone/Fax

Practice location:
  • Phone: 623-521-4204
  • Fax:
Mailing address:
  • Phone: 623-521-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESUS ANTONIO LOVETT II
Title or Position: MANAGING MEMBER
Credential:
Phone: 623-521-4204