Healthcare Provider Details

I. General information

NPI: 1629370978
Provider Name (Legal Business Name): EMILY LYFORD M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 E MULE DEER DR
SPRING VALLEY AZ
86333-4218
US

IV. Provider business mailing address

PO BOX 1059
MAYER AZ
86333-1059
US

V. Phone/Fax

Practice location:
  • Phone: 928-642-1007
  • Fax: 928-632-4005
Mailing address:
  • Phone: 928-642-1007
  • Fax: 928-632-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3778980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: