Healthcare Provider Details

I. General information

NPI: 1477319762
Provider Name (Legal Business Name): JAYDEN DODEN BA BHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23460 N 19TH AVE STE 220
PHOENIX AZ
85027-2170
US

IV. Provider business mailing address

17505 N 79TH AVE STE 105
GLENDALE AZ
85308-8724
US

V. Phone/Fax

Practice location:
  • Phone: 602-989-8899
  • Fax: 602-900-0969
Mailing address:
  • Phone: 602-989-8899
  • Fax: 602-900-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBHT
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: