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General NPI Number Information
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NPI Number | 1063105302
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Entity Type | Organization
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Legal Business Name | SOUTHERN ARIZONA PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 2198 E CAMELBACK RD STE 210A
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City | PHOENIX
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State | AZ
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Zip | 85016-4746
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Country | US
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Telephone | 480-442-8340
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Fax |
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Provider Business Mailing Address
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Address Line | 15252 N 100TH ST UNIT 2162
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3896
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE REYNOLDS
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Credential |
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Telephone | 480-442-8340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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