Provider Demographics
NPI:1366834533
Name:BPS ADVANCED WELLNESS, PLLC
Entity Type:Organization
Organization Name:BPS ADVANCED WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-292-2881
Mailing Address - Street 1:14441 W MCDOWELL RD
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2519
Mailing Address - Country:US
Mailing Address - Phone:602-292-2881
Mailing Address - Fax:
Practice Address - Street 1:14441 W MCDOWELL RD
Practice Address - Street 2:SUITE B-102
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2519
Practice Address - Country:US
Practice Address - Phone:602-292-2881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty