Provider Demographics
NPI:1912342924
Name:FITZHARRIS, BLYTHE A (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:BLYTHE
Middle Name:A
Last Name:FITZHARRIS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 N PLEASANT DR UNIT 2107
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7933
Mailing Address - Country:US
Mailing Address - Phone:602-920-0486
Mailing Address - Fax:
Practice Address - Street 1:2255 W NORTHERN AVE
Practice Address - Street 2:SUITE B100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4936
Practice Address - Country:US
Practice Address - Phone:602-995-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-105421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical