Provider Demographics
NPI:1417322470
Name:PHOENIX PSYCHOLOGY AND COUNSELING LLC
Entity type:Organization
Organization Name:PHOENIX PSYCHOLOGY AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:602-633-5474
Mailing Address - Street 1:PO BOX 41191
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1191
Mailing Address - Country:US
Mailing Address - Phone:602-633-5474
Mailing Address - Fax:602-733-6471
Practice Address - Street 1:3240 E UNION HILLS DR STE 133
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-2629
Practice Address - Country:US
Practice Address - Phone:602-633-5474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4457OtherSTATE LICENSE