Healthcare Provider Details

I. General information

NPI: 1548808405
Provider Name (Legal Business Name): MCGADY & ASSOCIATES PSYCHOLOGICAL SERVICES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 W OLIVE AVE STE 151A
GLENDALE AZ
85302-3843
US

IV. Provider business mailing address

4425 W OLIVE AVE STE 151
GLENDALE AZ
85302-3855
US

V. Phone/Fax

Practice location:
  • Phone: 602-456-4817
  • Fax: 480-247-4318
Mailing address:
  • Phone: 602-456-4817
  • Fax: 480-247-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DAVID MCGADY
Title or Position: CEO
Credential: PSY. D.,
Phone: 602-402-0971