Healthcare Provider Details

I. General information

NPI: 1689114878
Provider Name (Legal Business Name): ARIZONA PSYCHOLOGY AND WELLNESS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 S PRIEST DR STE 102
TEMPE AZ
85284-3605
US

IV. Provider business mailing address

9855 S PRIEST DR STE 102
TEMPE AZ
85284-3605
US

V. Phone/Fax

Practice location:
  • Phone: 480-430-6346
  • Fax:
Mailing address:
  • Phone: 480-430-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4826
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4826
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4826
License Number StateAZ

VIII. Authorized Official

Name: MAUREEN KIM KEAVENY
Title or Position: PSYCHOLOGIST
Credential:
Phone: 480-430-6346