Healthcare Provider Details

I. General information

NPI: 1992242002
Provider Name (Legal Business Name): PATRICIA PARZYCK PATHUIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-342-2161
  • Fax: 480-342-3786
Mailing address:
  • Phone: 480-342-2161
  • Fax: 480-342-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 11597
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: