Healthcare Provider Details

I. General information

NPI: 1972449007
Provider Name (Legal Business Name): ARIZONA DEVELOPMENTAL PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 E SHEA BLVD STE 200
PHOENIX AZ
85028-3348
US

IV. Provider business mailing address

11431 N 39TH PL
PHOENIX AZ
85028-2102
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-3288
  • Fax:
Mailing address:
  • Phone: 602-675-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA AARON HACKWELL
Title or Position: OWNER/FOUNDER
Credential:
Phone: 602-675-3288