Healthcare Provider Details

I. General information

NPI: 1649403544
Provider Name (Legal Business Name): ADHD CLINICS OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W UNIVERSITY AVE 202
FLAGSTAFF AZ
86001-2994
US

IV. Provider business mailing address

1016 W UNIVERSITY AVE 202
FLAGSTAFF AZ
86001-2994
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-7774
  • Fax: 928-774-1148
Mailing address:
  • Phone: 928-773-7774
  • Fax: 928-774-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number3125
License Number StateAZ

VIII. Authorized Official

Name: DR. BRUCE PACKARD
Title or Position: PARTNER
Credential: ED.D., PC
Phone: 928-773-7774