Provider Demographics
NPI:1023089034
Name:HIGGINS, DANE A (PHD)
Entity type:Individual
Prefix:DR
First Name:DANE
Middle Name:A
Last Name:HIGGINS
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 1:2440 N LITCHFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1664
Mailing Address - Country:US
Mailing Address - Phone:623-977-6860
Mailing Address - Fax:623-977-2016
Practice Address - Street 1:2440 N LITCHFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1664
Practice Address - Country:US
Practice Address - Phone:623-977-6860
Practice Address - Fax:623-977-2016
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3656103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ360382Medicaid
AZ874322Medicaid