Provider Demographics
NPI:1336011071
Name:GARDEN PSYCHOLOGY PLLC
Entity type:Organization
Organization Name:GARDEN PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYD
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-274-5291
Mailing Address - Street 1:7740 N 16TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4473
Mailing Address - Country:US
Mailing Address - Phone:802-274-5291
Mailing Address - Fax:
Practice Address - Street 1:7740 N 16TH ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4473
Practice Address - Country:US
Practice Address - Phone:802-274-5291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty