Provider Demographics
NPI:1225377443
Name:LAIZURE, BRECKEN R (PSYD)
Entity type:Individual
Prefix:
First Name:BRECKEN
Middle Name:R
Last Name:LAIZURE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 E MCDONALD DR
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6052
Mailing Address - Country:US
Mailing Address - Phone:480-946-0801
Mailing Address - Fax:480-946-0814
Practice Address - Street 1:7500 E MCDONALD DR
Practice Address - Street 2:SUITE 400A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6052
Practice Address - Country:US
Practice Address - Phone:480-946-0801
Practice Address - Fax:480-946-0814
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical