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General NPI Number Information
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NPI Number | 1467700138
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Entity Type | Organization
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Legal Business Name | PSYCH NETWORK P.C.
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 1011 N CRAYCROFT RD SUITE 400
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City | TUCSON
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State | AZ
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Zip | 85711-7309
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Country | US
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Telephone | 520-318-4930
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Fax |
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Provider Business Mailing Address
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Address Line | 8987 E TANQUE VERDE RD SUITE 309-383
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City | TUCSON
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State | AZ
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Zip | 85749-9610
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Country | US
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Telephone | 520-318-4930
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NELSON H DE JESUS
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Credential | PH.D.
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Telephone | 520-318-4930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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