Healthcare Provider Details

I. General information

NPI: 1013925296
Provider Name (Legal Business Name): ARIZONA STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S FOREST AVE # 334
TEMPE AZ
85287-1012
US

IV. Provider business mailing address

PO BOX 5199
ABILENE TX
79608-5199
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-6147
  • Fax: 480-965-3426
Mailing address:
  • Phone: 866-890-6390
  • Fax: 325-437-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ARRENDONDO
Title or Position: DEPUTY VP/UNIV DEAN STUDENT AFFAIR
Credential:
Phone: 480-965-3346