Healthcare Provider Details

I. General information

NPI: 1952279622
Provider Name (Legal Business Name): PATRICK S BURDELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
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

5308 N BREMONT WAY
PRESCOTT VALLEY AZ
86314-5812
US

V. Phone/Fax

Practice location:
  • Phone: 844-385-3747
  • Fax:
Mailing address:
  • Phone: 928-420-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23353
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: