=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295387868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JIGSAW BEHAVIORAL ACADEMY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2019
-----------------------------------------------------
Last Update Date | 02/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9375 E SHEA BLVD STE 100
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-6986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-560-6272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1551 48TH AVE
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39307-5413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-300-9496
-----------------------------------------------------
Fax | 901-666-8440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. DONESHA KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 26-560-6272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------