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General NPI Number Information
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NPI Number | 1063057768
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Entity Type | Individual
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Provider Name | JOY TODD
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Gender | Female
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Dates
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Enumeration Date | 11/17/2019
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Last Update Date | 11/17/2019
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Provider Practice Location Address
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Address Line | 104 W WIGWAM BLVD STE 104
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-4659
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Country | US
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Telephone | 609-319-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 5715 S 21ST TER
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City | PHOENIX
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State | AZ
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Zip | 85040-3448
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Country | US
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Telephone | 609-319-1776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 17631
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License Number State | AZ
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