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General NPI Number Information
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NPI Number | 1225584030
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Entity Type | Organization
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Legal Business Name | SOJOURNER HEALTH
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 2224 E FILLMORE ST
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City | PHOENIX
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State | AZ
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Zip | 85006-3815
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Country | US
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Telephone | 602-296-3337
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20156
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City | PHOENIX
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State | AZ
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Zip | 85036-0156
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Country | US
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Telephone | 602-296-3337
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. ROBERT L KNECHTEL
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Credential | MD, JD
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Telephone | 602-296-3337
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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 | 3924
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License Number State | AZ
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