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General NPI Number Information
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NPI Number | 1972691095
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Entity Type | Individual
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Provider Name | LESLIE DANA-KIRBY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 14780 W MOUNTAIN VIEW BLVD SUITE 110
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City | SURPRISE
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State | AZ
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Zip | 85374-4799
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Country | US
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Telephone | 623-374-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 14635 W FAIRMOUNT AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-8279
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Country | US
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Telephone | 623-606-7243
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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 | 3320
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License Number State | AZ
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