Provider Demographics
NPI:1942333760
Name:PSYCHIATRIC ASSOCIATES OF NORTHERN AZ PLLC
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF NORTHERN AZ PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:PENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-8400
Mailing Address - Street 1:141 SOUTH MCCORMICK
Mailing Address - Street 2:SUITE #200
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4731
Mailing Address - Country:US
Mailing Address - Phone:928-445-8400
Mailing Address - Fax:928-776-0208
Practice Address - Street 1:141 SOUTH MCCORMICK
Practice Address - Street 2:SUITE #200
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4731
Practice Address - Country:US
Practice Address - Phone:928-445-8400
Practice Address - Fax:928-776-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235207424OtherNPI
1063590297OtherNPI