MEDICARE: THE DEVEREUX FOUNDATION

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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	BH-721	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	448713	OTHER	AZ	AHCCCS ID

General Provider Information

NPI Number	:	1003913385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DEVEREUX FOUNDATION

Provider Business Mailing Address
First Line	:	11000 N SCOTTSDALE RD STE 260
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-6200
Country	:	US
Telephone Number	:	480-998-2920
Fax Number	:

Provider Business Practice Location Address
First Line	:	6141 E GRANT RD BLDG A
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-5829
Country	:	US
Telephone Number	:	520-296-5551
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LANE MARTIN-BARKER
Credential	:
Telephone Number	:	480-998-2920

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/13/2026

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Directions to “THE DEVEREUX FOUNDATION ” Practice Location

Language	Start Address	Practice Location

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