Provider Demographics
NPI:1346413051
Name:THERESA A. GATES, PH.D., P.C.
Entity Type:Organization
Organization Name:THERESA A. GATES, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-451-1684
Mailing Address - Street 1:8075 E MORGAN TRL
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1293
Mailing Address - Country:US
Mailing Address - Phone:480-451-1684
Mailing Address - Fax:480-451-1684
Practice Address - Street 1:8075 E MORGAN TRL
Practice Address - Street 2:SUITE 1-B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1293
Practice Address - Country:US
Practice Address - Phone:480-451-1684
Practice Address - Fax:480-451-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3397261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104799Medicare PIN