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NPI Code Detail

MEDICARE: PSYCHOLOGICAL & BEHAVIORAL CONSULTANTS, LLC

MEDICARE: PSYCHOLOGICAL & BEHAVIORAL CONSULTANTS, LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2101YM0800XMental Health Counselor
3261QM0850XAdult Mental Health Clinic/Center
4103TC0700XClinical Psychologist
51041C0700XClinical Social Worker
6261Q00000XClinic/Center
7261QM0855XAdolescent and Children Mental Health Clinic/Center
82084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1811915713
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSYCHOLOGICAL & BEHAVIORAL CONSULTANTS, LLC
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number : 216-468-5000
Fax Number : 216-456-8128
Provider Business Practice Location Address
First Line : 25101 CHAGRIN BLVD STE 100
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5694
Country : US
Telephone Number : 216-468-5000
Fax Number : 216-456-8128
Authorized Official
Title or Position : CHIEF LEGAL OFFICER
Name : MR. RYAN PARDO
Credential :
Telephone Number : 425-279-8500
Provider Enumeration Date : 07/18/2006
Last Update Date : 11/04/2024

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