Provider Demographics
NPI:1043086838
Name:PACKARD, JASON MATTHEW
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:PACKARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 E ESCALANTE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-3239
Mailing Address - Country:US
Mailing Address - Phone:253-209-1279
Mailing Address - Fax:
Practice Address - Street 1:3820 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3227
Practice Address - Country:US
Practice Address - Phone:520-843-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker