Healthcare Provider Details

I. General information

NPI: 1518876481
Provider Name (Legal Business Name): ELIZABETH KERSEY STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD STE 2750
PHOENIX AZ
85032-2128
US

IV. Provider business mailing address

6790 E CALLE LA PAZ UNIT 5205
TUCSON AZ
85715-9012
US

V. Phone/Fax

Practice location:
  • Phone: 520-595-5500
  • Fax:
Mailing address:
  • Phone: 520-250-4894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: