Healthcare Provider Details

I. General information

NPI: 1588808745
Provider Name (Legal Business Name): PSI BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E OSBORN RD
SCOTTSDALE AZ
85251-6432
US

IV. Provider business mailing address

7301 E 3RD AVE UNIT 405
SCOTTSDALE AZ
85251-4451
US

V. Phone/Fax

Practice location:
  • Phone: 660-341-5030
  • Fax:
Mailing address:
  • Phone: 660-341-5030
  • Fax: 480-773-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4012
License Number StateAZ

VIII. Authorized Official

Name: DR. RENE J MCGOVERN
Title or Position: MANAGER/OWNER
Credential: PH.D.
Phone: 660-341-5030