Provider Demographics
NPI:1235217365
Name:ENGELHARD, BERNARD E (PHD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:E
Last Name:ENGELHARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 N COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1200
Mailing Address - Country:US
Mailing Address - Phone:520-325-2723
Mailing Address - Fax:520-325-7207
Practice Address - Street 1:3444 N COUNTRY CLUB RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1200
Practice Address - Country:US
Practice Address - Phone:520-325-2723
Practice Address - Fax:520-325-7207
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0672103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0606590OtherBC/BS
AZAZ0606590OtherBC/BS
AZNPP000Medicare UPIN