Provider Demographics
NPI:1013985639
Name:LEROY, JAMES A (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LEROY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 W BELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9002
Mailing Address - Country:US
Mailing Address - Phone:623-374-7774
Mailing Address - Fax:623-240-1110
Practice Address - Street 1:12425 W BELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9006
Practice Address - Country:US
Practice Address - Phone:623-374-7774
Practice Address - Fax:623-240-1110
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ066672Medicaid
Z120245Medicare PIN
Z82930Medicare PIN
AZZ92244Medicare PIN
AZ066672Medicaid
R10379Medicare UPIN