Provider Demographics
NPI:1972041242
Name:MARICOPA COUNTY ADULT PROBATION
Entity Type:Organization
Organization Name:MARICOPA COUNTY ADULT PROBATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-506-3262
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85030-3407
Mailing Address - Country:US
Mailing Address - Phone:602-506-3262
Mailing Address - Fax:
Practice Address - Street 1:620 W JACKSON ST
Practice Address - Street 2:SUITE 3098
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2403
Practice Address - Country:US
Practice Address - Phone:602-506-3262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZLAC 12055305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of Service