Provider Demographics
NPI:1770587032
Name:STECKAL, DONNA S (PHD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:S
Last Name:STECKAL
Suffix:
Gender:F
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:PO BOX 2204
Mailing Address - Street 2:616 S BEELINE HWY STE 107
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-2204
Mailing Address - Country:US
Mailing Address - Phone:928-474-4452
Mailing Address - Fax:928-474-4898
Practice Address - Street 1:616 S BEELINE HWY STE 107
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5380
Practice Address - Country:US
Practice Address - Phone:928-474-4452
Practice Address - Fax:928-474-4898
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3131103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ636087OtherAHCCCS
AZ636087OtherAHCCCS