Healthcare Provider Details

I. General information

NPI: 1407775133
Provider Name (Legal Business Name): SELENA SCOFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 N CENTRAL AVE STE 2500
PHOENIX AZ
85012-2505
US

IV. Provider business mailing address

3300 N CENTRAL AVE STE 2500
PHOENIX AZ
85012-2505
US

V. Phone/Fax

Practice location:
  • Phone: 602-427-2370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number521590951
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: