Provider Demographics
NPI:1487909669
Name:PEDIATRIC PSYCHOLOGY ASSOCIATES, LTD.
Entity type:Organization
Organization Name:PEDIATRIC PSYCHOLOGY ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:RELPH
Authorized Official - Last Name:SAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-296-4280
Mailing Address - Street 1:1980 E FORT LOWELL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2326
Mailing Address - Country:US
Mailing Address - Phone:520-296-4280
Mailing Address - Fax:520-296-3835
Practice Address - Street 1:1980 E FORT LOWELL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2326
Practice Address - Country:US
Practice Address - Phone:520-296-4280
Practice Address - Fax:520-296-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4202103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty