Provider Demographics
NPI:1205018900
Name:PSYCHIATRY AND COUNSELING
Entity Type:Organization
Organization Name:PSYCHIATRY AND COUNSELING
Other - Org Name:AZ PSYCHIATRY AND COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARDEV
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-966-1485
Mailing Address - Street 1:PO BOX 23687
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-3687
Mailing Address - Country:US
Mailing Address - Phone:480-966-1485
Mailing Address - Fax:480-968-5020
Practice Address - Street 1:1050 E SOUTHERN AVE
Practice Address - Street 2:G 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5403
Practice Address - Country:US
Practice Address - Phone:480-966-1485
Practice Address - Fax:480-968-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ07364OtherSUBMITTER ID
AZAZ07364OtherSUBMITTER ID