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General NPI Number Information
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NPI Number | 1922401496
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Entity Type | Organization
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Legal Business Name | PRONGHORN PSYCHIATRY INC
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 5940 E. COPPER HILL DR. STE. B
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314
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Country | US
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Telephone | 928-583-7799
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Fax | 928-583-7891
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Provider Business Mailing Address
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Address Line | 5940 E COPPER HILL DR STE B
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2860
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Country | US
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Telephone | 928-583-7799
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Fax | 928-583-7891
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSEPH DANIEL LETENDRE
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Credential |
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Telephone | 928-583-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | IFBH6794
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License Number State | AZ
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