Provider Demographics
NPI:1174672695
Name:EDDY, JIMMY D (MA)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:D
Last Name:EDDY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W ORIOLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3274
Mailing Address - Country:US
Mailing Address - Phone:480-632-4750
Mailing Address - Fax:480-892-6553
Practice Address - Street 1:140 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1016
Practice Address - Country:US
Practice Address - Phone:480-632-4750
Practice Address - Fax:480-632-6533
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist