Provider Demographics
NPI:1477319762
Name:DODEN, JAYDEN (BA BHT)
Entity Type:Individual
Prefix:
First Name:JAYDEN
Middle Name:
Last Name:DODEN
Suffix:
Gender:F
Credentials:BA BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17505 N 79TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8724
Mailing Address - Country:US
Mailing Address - Phone:602-989-8899
Mailing Address - Fax:602-900-0969
Practice Address - Street 1:23460 N 19TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2170
Practice Address - Country:US
Practice Address - Phone:602-989-8899
Practice Address - Fax:602-900-0969
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHT101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1740851542OtherJANUARY HARTZE OF HEALING HARTZE INDIVIDUAL NPI
AZCSLG13230OtherARIZONA DEPARTMENT OF HEALTH SERVICES
AZ1043982747OtherNPI TYPE 2 ORGANIZATIONAL/FACILITY
AZ125011Medicaid