MEDICARE: DR. ALICE PICKERING PSY D

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	PSY-005058	AZ

General Provider Information

NPI Number	:	1336705888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE PICKERING PSY D

Provider Business Mailing Address
First Line	:	20280 N 59TH AVE STE 115-136
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6850
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20280 N 59TH AVE STE 115-136
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6850
Country	:	US
Telephone Number	:	623-570-1895
Fax Number	:

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

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	08/30/2021

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