Healthcare Provider Details

I. General information

NPI: 1841380029
Provider Name (Legal Business Name): JUDITH LYNN PIKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 WINROW AVE USAMEDDAC , RWBAHC
FT. HUACHUCA AZ
85613-7079
US

IV. Provider business mailing address

1023 ESSEX DR
SIERRA VISTA AZ
85635-4926
US

V. Phone/Fax

Practice location:
  • Phone: 520-538-0628
  • Fax: 520-533-5715
Mailing address:
  • Phone: 520-459-1752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-1535
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: