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General NPI Number Information
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NPI Number | 1972833218
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Entity Type | Organization
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Legal Business Name | SUNLIGHT CENTER FOR CHANGE
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 780 N PROMONTORY DR
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City | TUCSON
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State | AZ
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Zip | 85748-3545
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Country | US
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Telephone | 520-344-0056
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Fax |
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Provider Business Mailing Address
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Address Line | 120 S HOUGHTON RD #138-200
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City | TUCSON
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State | AZ
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Zip | 85748-6731
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Country | US
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Telephone | 520-344-0056
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. HOLLY JINDRICK
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Credential | PSY.D.
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Telephone | 520-344-0056
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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 | 3963
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License Number State | AZ
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