Healthcare Provider Details

I. General information

NPI: 1962433425
Provider Name (Legal Business Name): DAVID DALE FERO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HIGHWAY 89 MENTAL HEALTH 116
PRESCOTT AZ
86313
US

IV. Provider business mailing address

257 WHISPER RDG
PRESCOTT AZ
86301-4211
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4860
  • Fax: 928-776-6125
Mailing address:
  • Phone: 928-445-4960
  • Fax: 928-776-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3528
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: