Healthcare Provider Details

I. General information

NPI: 1356709836
Provider Name (Legal Business Name): ARIZONA NEUROFEEDBACK CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7592 E PALO VERDE ST SUITE A
PRESCOTT VALLEY AZ
86314-3235
US

IV. Provider business mailing address

7592 E PALO VERDE ST SUITE A
PRESCOTT VALLEY AZ
86314-3235
US

V. Phone/Fax

Practice location:
  • Phone: 928-227-2900
  • Fax: 928-277-1494
Mailing address:
  • Phone: 928-227-2900
  • Fax: 928-277-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT P DIAMOND
Title or Position: DIRECTOR
Credential: M.A.
Phone: 928-227-2900