Healthcare Provider Details

I. General information

NPI: 1598570285
Provider Name (Legal Business Name): TEHRA STORMS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 168
GLENDALE AZ
85308-4624
US

IV. Provider business mailing address

2339 S BANNING ST
GILBERT AZ
85295-0508
US

V. Phone/Fax

Practice location:
  • Phone: 844-385-3747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005944
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: