Healthcare Provider Details

I. General information

NPI: 1922401496
Provider Name (Legal Business Name): PRONGHORN PSYCHIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 E. COPPER HILL DR. STE. B
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

5940 E COPPER HILL DR STE B
PRESCOTT VALLEY AZ
86314-2860
US

V. Phone/Fax

Practice location:
  • Phone: 928-583-7799
  • Fax: 928-583-7891
Mailing address:
  • Phone: 928-583-7799
  • Fax: 928-583-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberIFBH6794
License Number StateAZ

VIII. Authorized Official

Name: MR. JOSEPH DANIEL LETENDRE
Title or Position: CEO
Credential:
Phone: 928-583-7799