Healthcare Provider Details

I. General information

NPI: 1295387868
Provider Name (Legal Business Name): JIGSAW BEHAVIORAL ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 E SHEA BLVD STE 100
SCOTTSDALE AZ
85260-6986
US

IV. Provider business mailing address

1551 48TH AVE
MERIDIAN MS
39307-5413
US

V. Phone/Fax

Practice location:
  • Phone: 602-560-6272
  • Fax:
Mailing address:
  • Phone: 901-300-9496
  • Fax: 901-666-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONESHA KING
Title or Position: CEO
Credential:
Phone: 26-560-6272