Provider Demographics
NPI:1760525455
Name:SIERRA VISTA PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:SIERRA VISTA PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:CSP
Authorized Official - Phone:520-515-2790
Mailing Address - Street 1:2112 W. SAGUARO ROAD.
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643
Mailing Address - Country:US
Mailing Address - Phone:520-384-3265
Mailing Address - Fax:
Practice Address - Street 1:3555 FRY BOULEVARD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-515-2790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicaid