Healthcare Provider Details

I. General information

NPI: 1295907426
Provider Name (Legal Business Name): VIJAY K. JAIN, PSY.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4232 E CACTUS RD SUITE 207
PHOENIX AZ
85032-7602
US

IV. Provider business mailing address

4232 E CACTUS RD SUITE 207
PHOENIX AZ
85032-7602
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-8105
  • Fax: 602-494-8108
Mailing address:
  • Phone: 602-494-8105
  • Fax: 602-494-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3009
License Number StateAZ

VIII. Authorized Official

Name: DR. VIJAY K JAIN
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 602-494-8105