Provider Demographics
NPI:1851542112
Name:SAX-PAHL, KELLI ROBYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ROBYN
Last Name:SAX-PAHL
Suffix:
Gender:F
Credentials:LCSW
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Other - Credentials:
Mailing Address - Street 1:1400 E. SOUTHERN AVE
Mailing Address - Street 2:STE. 735
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2692
Mailing Address - Country:US
Mailing Address - Phone:480-804-0326
Mailing Address - Fax:480-804-0083
Practice Address - Street 1:10799 N 90TH ST
Practice Address - Street 2:STE. 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6110
Practice Address - Country:US
Practice Address - Phone:480-804-0326
Practice Address - Fax:480-804-0083
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZLCSW-26211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ387040Medicaid
AZ387040Medicaid