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General NPI Number Information
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NPI Number | 1649403544
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Entity Type | Organization
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Legal Business Name | ADHD CLINICS OF ARIZONA
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 1016 W UNIVERSITY AVE 202
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-2994
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Country | US
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Telephone | 928-773-7774
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Fax | 928-774-1148
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Provider Business Mailing Address
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Address Line | 1016 W UNIVERSITY AVE 202
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-2994
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Country | US
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Telephone | 928-773-7774
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Fax | 928-774-1148
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Authorized Official
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Title or Position | PARTNER
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Name | DR. BRUCE PACKARD
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Credential | ED.D., PC
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Telephone | 928-773-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 3125
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License Number State | AZ
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