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General NPI Number Information
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NPI Number | 1366324642
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Entity Type | Individual
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Provider Name | DR. JACK DEEMING
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Gender |
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 7600 N 15TH ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85020-4330
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Country | US
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Telephone | 602-224-2277
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Fax |
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Provider Business Mailing Address
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Address Line | 28425 N BLACK CANYON HWY UNIT 2062
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City | PHOENIX
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State | AZ
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Zip | 85085-7612
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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 |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-005901
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License Number State | AZ
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