Provider Demographics
NPI:1932348968
Name:GEARY, BRENT B (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:B
Last Name:GEARY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6509
Mailing Address - Country:US
Mailing Address - Phone:602-268-8404
Mailing Address - Fax:602-956-6196
Practice Address - Street 1:3618 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6509
Practice Address - Country:US
Practice Address - Phone:602-268-8404
Practice Address - Fax:602-956-6196
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2030103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist