Healthcare Provider Details

I. General information

NPI: 1790603470
Provider Name (Legal Business Name): ONE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8652 E EASTRIDGE RD STE 201
PRESCOTT VALLEY AZ
86314-9464
US

IV. Provider business mailing address

8652 E EASTRIDGE RD STE 201
PRESCOTT VALLEY AZ
86314-9464
US

V. Phone/Fax

Practice location:
  • Phone: 928-830-2410
  • Fax: 866-560-2226
Mailing address:
  • Phone: 928-830-2410
  • Fax: 866-560-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA ANNIBALE
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 928-642-8575