Healthcare Provider Details

I. General information

NPI: 1417322470
Provider Name (Legal Business Name): PHOENIX PSYCHOLOGY AND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 E UNION HILLS DR STE 133
PHOENIX AZ
85050-2629
US

IV. Provider business mailing address

PO BOX 41191
PHOENIX AZ
85080-1191
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-5474
  • Fax:
Mailing address:
  • Phone: 602-633-5474
  • Fax: 602-733-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROXANNE HAIT
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 602-633-5474