Healthcare Provider Details

I. General information

NPI: 1316009145
Provider Name (Legal Business Name): JEWISH FAMILY & CHILDREN'S SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W TALAVI BLVD STE 180
GLENDALE AZ
85306-1888
US

IV. Provider business mailing address

4747 N 7TH ST STE 100
PHOENIX AZ
85014-3654
US

V. Phone/Fax

Practice location:
  • Phone: 623-486-8202
  • Fax: 623-486-2739
Mailing address:
  • Phone: 602-279-7655
  • Fax: 602-253-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LORRIE HENDERSON
Title or Position: PRESIDENT AND CEO
Credential: PHD, MBA, LCSW
Phone: 602-279-7655