Provider Demographics
NPI:1700095122
Name:PARDEE, DEBORAH JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:JEAN
Last Name:PARDEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:PARDEE
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11597
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-1597
Mailing Address - Country:US
Mailing Address - Phone:928-227-7482
Mailing Address - Fax:
Practice Address - Street 1:703 S MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4615
Practice Address - Country:US
Practice Address - Phone:928-227-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003715103TC1900X
AZ4264103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLP 4264OtherSTATE OF ARIZONA