Healthcare Provider Details

I. General information

NPI: 1821666439
Provider Name (Legal Business Name): SOUTHWEST AUTISM RESEARCH AND RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 18TH ST
PHOENIX AZ
85006-4103
US

IV. Provider business mailing address

2225 N 16TH ST
PHOENIX AZ
85006-1823
US

V. Phone/Fax

Practice location:
  • Phone: 602-340-8717
  • Fax:
Mailing address:
  • Phone: 602-340-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SHAW
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 602-340-8717