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General NPI Number Information
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NPI Number | 1730432188
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Entity Type | Organization
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Legal Business Name | KIDSCOPE LLC
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 13055 W MCDOWELL RD SUITE G-112
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City | AVONDALE
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State | AZ
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Zip | 85392-6449
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Country | US
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Telephone | 602-792-5021
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Fax | 602-792-5262
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Provider Business Mailing Address
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Address Line | 13055 W MCDOWELL RD SUITE G-112
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City | AVONDALE
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State | AZ
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Zip | 85392-6449
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Country | US
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Telephone | 623-792-5021
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Fax | 623-792-5262
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Authorized Official
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Title or Position | CEO/MANAGING MEMBER
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Name | MS. PAMELA S DAVIS
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Credential |
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Telephone | 602-614-9197
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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 |
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License Number State | AZ
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