Provider Demographics
NPI:1558052472
Name:SHEATS, ALICIA (PSS, BHPP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:SHEATS
Suffix:
Gender:F
Credentials:PSS, BHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 W SHANGRI LA RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4029
Mailing Address - Country:US
Mailing Address - Phone:602-725-5164
Mailing Address - Fax:
Practice Address - Street 1:3824 W SHANGRI LA RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4029
Practice Address - Country:US
Practice Address - Phone:602-725-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health