Provider Demographics
NPI:1013447127
Name:JASON R. NEWELL, PH.D.
Entity Type:Organization
Organization Name:JASON R. NEWELL, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-478-0576
Mailing Address - Street 1:11110 N TATUM BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1607
Mailing Address - Country:US
Mailing Address - Phone:602-478-0576
Mailing Address - Fax:
Practice Address - Street 1:11110 N TATUM BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1607
Practice Address - Country:US
Practice Address - Phone:602-478-0576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty