MEDICARE: PROFESSIONAL PSYCHOLOGY ASSOCIATES PC

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	103TR0400X	Rehabilitation Psychologist	BH934	AZ

General Provider Information

NPI Number	:	1821003419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PSYCHOLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	4222 E CAMELBACK RD
Second Line	:	SUITE H230
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2745
Country	:	US
Telephone Number	:	602-852-0911
Fax Number	:	602-852-0632

Provider Business Practice Location Address
First Line	:	4222 E CAMELBACK RD
Second Line	:	SUITE H230
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2745
Country	:	US
Telephone Number	:	602-852-0911
Fax Number	:	602-852-0632

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. PHILLIP D LETT
Credential	:	PHD
Telephone Number	:	602-852-0911

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/22/2020

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