Healthcare Provider Details

I. General information

NPI: 1134053770
Provider Name (Legal Business Name): FOUNDRY PEDIATRIC BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 S 75TH DR
PHOENIX AZ
85043-1220
US

IV. Provider business mailing address

3717 S 75TH DR
PHOENIX AZ
85043-1220
US

V. Phone/Fax

Practice location:
  • Phone: 619-955-5533
  • Fax:
Mailing address:
  • Phone: 619-955-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SIRIKARN SANPUNDORN
Title or Position: FOUNDER
Credential: BCBA, LBA
Phone: 619-905-5533