Healthcare Provider Details

I. General information

NPI: 1508684101
Provider Name (Legal Business Name): BRANDON A SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 32ND ST
PHOENIX AZ
85008-6205
US

IV. Provider business mailing address

10805 W LONE CACTUS DR
SUN CITY AZ
85373-8737
US

V. Phone/Fax

Practice location:
  • Phone: 602-914-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005822
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: