Provider Demographics
NPI:1174928410
Name:CHOI, MEENA (PHD)
Entity type:Individual
Prefix:
First Name:MEENA
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10184 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE NUMBER 190
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1254
Mailing Address - Country:US
Mailing Address - Phone:623-824-5051
Mailing Address - Fax:623-889-9000
Practice Address - Street 1:10184 W HAPPY VALLEY RD
Practice Address - Street 2:SUITE NUMBER 190
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1254
Practice Address - Country:US
Practice Address - Phone:623-824-5051
Practice Address - Fax:623-889-9000
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4431103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent