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NPI Code Detail

MEDICARE: BETTY LEE DARBY PH.D.

MEDICARE: BETTY LEE DARBY PH.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
1103TC0700XClinical Psychologist853WA
2103TC0700XClinical Psychologist3590AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10618820OTHERAZBLUE CROSS PROVIDER #

General Provider Information

NPI Number : 1871637322
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTY LEE DARBY PH.D.
Provider Business Mailing Address
First Line : 1356 SIERRY PEAKS DR
Second Line :
City : PRESCOTT
State : AZ
Zip : 86305-5155
Country : US
Telephone Number : 928-443-7440
Fax Number :
Provider Business Practice Location Address
First Line : 1129 W IRON SPRINGS RD
Second Line : #213
City : PRESCOTT
State : AZ
Zip : 86305-1623
Country : US
Telephone Number : 928-777-2372
Fax Number : 928-777-2361
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2007
Last Update Date : 07/08/2007

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