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NPI Code Detail

MEDICARE: EAST VALLEY CHILD PSYCHOLOGY

MEDICARE: EAST VALLEY CHILD PSYCHOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1003469057
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST VALLEY CHILD PSYCHOLOGY
Provider Business Mailing Address
First Line : 3331 S HUACHUCA WAY
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-0094
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1910 S STAPLEY DR STE 221
Second Line :
City : MESA
State : AZ
Zip : 85204-6680
Country : US
Telephone Number : 480-202-1285
Fax Number :
Authorized Official
Title or Position : LICENSED PSYCHOLOGIST
Name : DR. MADISON KNIGHT
Credential : PHD
Telephone Number : 480-202-1285
Provider Enumeration Date : 07/18/2019
Last Update Date : 07/18/2019

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Directions to “EAST VALLEY CHILD PSYCHOLOGY ” Practice Location

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