MEDICARE: DR. DANE A HIGGINS PHD

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	103TC0700X	Clinical Psychologist	3656	AZ
2	103G00000X	Clinical Neuropsychologist	3656	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023089034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANE A HIGGINS PHD

Provider Business Mailing Address
First Line	:	2440 N LITCHFIELD RD STE 200
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-1664
Country	:	US
Telephone Number	:	623-977-6860
Fax Number	:	623-977-2016

Provider Business Practice Location Address
First Line	:	2440 N LITCHFIELD RD STE 200
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-1664
Country	:	US
Telephone Number	:	623-977-6860
Fax Number	:	623-977-2016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	02/26/2024

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