Healthcare Provider Details

I. General information

NPI: 1053237073
Provider Name (Legal Business Name): PSYCHOLOGICAL SERVICES AZ PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 W RAY RD STE 15-119
CHANDLER AZ
85226-1699
US

IV. Provider business mailing address

6909 W RAY RD STE 15-119
CHANDLER AZ
85226-1699
US

V. Phone/Fax

Practice location:
  • Phone: 480-613-9911
  • Fax:
Mailing address:
  • Phone: 480-613-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CALEB BARCENAS
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PHD
Phone: 503-758-2917