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General NPI Number Information
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NPI Number | 1104929504
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Entity Type | Organization
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Legal Business Name | PRISMA COMMUNITY CARE
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1101 N. CENTRAL AVENUE SUITE 200
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City | PHOENIX
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State | AZ
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Zip | 85004
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Country | US
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Telephone | 602-307-5330
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Fax | 602-307-5021
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Provider Business Mailing Address
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Address Line | 1101 N CENTRAL AVE STE 200
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City | PHOENIX
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State | AZ
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Zip | 85004-1844
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Country | US
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Telephone | 602-347-0873
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Fax | 602-246-1980
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | CASEY SIMON
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Credential |
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Telephone | 602-307-5330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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