Healthcare Provider Details

I. General information

NPI: 1255965901
Provider Name (Legal Business Name): EARLE & EARLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 E 6TH ST STE 21
TEMPE AZ
85281-2964
US

IV. Provider business mailing address

1835 E 6TH ST STE 21
TEMPE AZ
85281
US

V. Phone/Fax

Practice location:
  • Phone: 602-888-1447
  • Fax:
Mailing address:
  • Phone: 480-581-6981
  • Fax: 833-581-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER IAN EARLE
Title or Position: OWNER
Credential:
Phone: 480-581-6981