Provider Demographics
NPI:1184138588
Name:EAST VALLEY PCIT, PLLC
Entity type:Organization
Organization Name:EAST VALLEY PCIT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:DELUCENAY
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-777-7528
Mailing Address - Street 1:955 W CHANDLER BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4906
Mailing Address - Country:US
Mailing Address - Phone:602-777-7528
Mailing Address - Fax:602-900-0996
Practice Address - Street 1:955 W CHANDLER BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4906
Practice Address - Country:US
Practice Address - Phone:602-777-7528
Practice Address - Fax:602-900-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-168681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty