Provider Demographics
NPI:1710335104
Name:DYNAMIC PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:DYNAMIC PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:623-363-7451
Mailing Address - Street 1:501 E. CIRCLE PLAZA
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4917
Mailing Address - Country:US
Mailing Address - Phone:623-201-1002
Mailing Address - Fax:
Practice Address - Street 1:501 E PLAZA CIR
Practice Address - Street 2:STE B
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4917
Practice Address - Country:US
Practice Address - Phone:623-201-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4710251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health