Healthcare Provider Details

I. General information

NPI: 1023401965
Provider Name (Legal Business Name): TEMPE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S 48TH ST STE 109
TEMPE AZ
85281-2302
US

IV. Provider business mailing address

455 S 48TH ST STE 109
TEMPE AZ
85281-2302
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-2558
  • Fax: 480-945-2354
Mailing address:
  • Phone: 480-945-2558
  • Fax: 480-945-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. EKRAM EBRAHIM
Title or Position: OWNER/MANAGER
Credential:
Phone: 480-945-2558