Healthcare Provider Details

I. General information

NPI: 1336011071
Provider Name (Legal Business Name): GARDEN PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 N 16TH ST STE 300
PHOENIX AZ
85020-4473
US

IV. Provider business mailing address

7740 N 16TH ST STE 300
PHOENIX AZ
85020-4473
US

V. Phone/Fax

Practice location:
  • Phone: 802-274-5291
  • Fax:
Mailing address:
  • Phone: 802-274-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JACK GARDEN
Title or Position: PSYD
Credential:
Phone: 802-274-5291