Provider Demographics
NPI:1366180895
Name:CZECH, BRITTANY NICOLE (EDS)
Entity type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:NICOLE
Last Name:CZECH
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15940 N 171ST DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-0204
Mailing Address - Country:US
Mailing Address - Phone:630-346-2950
Mailing Address - Fax:
Practice Address - Street 1:15940 N 171ST DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-0204
Practice Address - Country:US
Practice Address - Phone:630-346-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4786533103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool