Healthcare Provider Details

I. General information

NPI: 1225027147
Provider Name (Legal Business Name): INTEGRATED GERIATRIC BEHAVIORAL HEALTH ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 N 85TH WAY
SCOTTSDALE AZ
85258-4321
US

IV. Provider business mailing address

PO BOX 6605
SCOTTSDALE AZ
85261-6605
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-9599
  • Fax: 480-585-6109
Mailing address:
  • Phone: 602-256-9599
  • Fax: 480-585-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA WILLSON
Title or Position: CO-OWNER
Credential: PHD
Phone: 602-256-9599