Provider Demographics
NPI:1205492972
Name:MARICOPA FAMILY PSYCHIATRY PLLC
Entity type:Organization
Organization Name:MARICOPA FAMILY PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISBIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:520-705-2249
Mailing Address - Street 1:42840 W BRAVO DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-9473
Mailing Address - Country:US
Mailing Address - Phone:520-705-2249
Mailing Address - Fax:
Practice Address - Street 1:42840 W BRAVO DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-9473
Practice Address - Country:US
Practice Address - Phone:520-705-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty