Provider Demographics
NPI:1972718047
Name:MCFADDEN, PATSY JEAN (LISAC)
Entity Type:Individual
Prefix:MS
First Name:PATSY
Middle Name:JEAN
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 N 124TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-6516
Mailing Address - Country:US
Mailing Address - Phone:623-261-3416
Mailing Address - Fax:
Practice Address - Street 1:2128 N 124TH DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-6516
Practice Address - Country:US
Practice Address - Phone:623-261-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11827101Y00000X
AZ11395101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)