Provider Demographics
NPI:1497964662
Name:ARIZONA CHILD PSYCHIATRY, PC
Entity Type:Organization
Organization Name:ARIZONA CHILD PSYCHIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-996-5040
Mailing Address - Street 1:11260 N TATUM BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2307
Mailing Address - Country:US
Mailing Address - Phone:602-996-5040
Mailing Address - Fax:602-996-5041
Practice Address - Street 1:11260 N TATUM BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-2307
Practice Address - Country:US
Practice Address - Phone:602-996-5040
Practice Address - Fax:602-996-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26172261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health