Provider Demographics
NPI:1649403544
Name:ADHD CLINICS OF ARIZONA
Entity Type:Organization
Organization Name:ADHD CLINICS OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, PC
Authorized Official - Phone:928-773-7774
Mailing Address - Street 1:1016 W UNIVERSITY AVE
Mailing Address - Street 2:202
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2994
Mailing Address - Country:US
Mailing Address - Phone:928-773-7774
Mailing Address - Fax:928-774-1148
Practice Address - Street 1:1016 W UNIVERSITY AVE
Practice Address - Street 2:202
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2994
Practice Address - Country:US
Practice Address - Phone:928-773-7774
Practice Address - Fax:928-774-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3125261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health