Provider Demographics
NPI:1508101551
Name:HOLLIDAY B. MILBY, PH.D.,P.C.
Entity Type:Organization
Organization Name:HOLLIDAY B. MILBY, PH.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLIDAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:623-910-2700
Mailing Address - Street 1:17505 N 79TH AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8725
Mailing Address - Country:US
Mailing Address - Phone:623-910-2700
Mailing Address - Fax:623-910-2700
Practice Address - Street 1:17505 N 79TH AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8725
Practice Address - Country:US
Practice Address - Phone:623-910-2700
Practice Address - Fax:623-910-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1227101YM0800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ67091Medicare PIN