Provider Demographics
NPI:1679623060
Name:DOUBRAVA, DEBORAH MCKINNEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MCKINNEY
Last Name:DOUBRAVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:10766 S DISTILLERY CANYON SPRING DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2560
Mailing Address - Country:US
Mailing Address - Phone:520-444-9387
Mailing Address - Fax:
Practice Address - Street 1:13801 E BENSON HWY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-9074
Practice Address - Country:US
Practice Address - Phone:520-444-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3450103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0618590OtherBLUE CROSS BLUE SHIELD ID
AZ765076Medicare UPIN
AZ0618590OtherBLUE CROSS BLUE SHIELD ID