| Arizona Childrens Therapy Center Llc | |
|
7545 W Redbird Rd Peoria AZ 85383-6253 | |
| (480) 510-1599 | |
| (623) 258-4136 |
| Full Name | Arizona Childrens Therapy Center Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 7545 W Redbird Rd, Peoria, Arizona |
| Authorized Official Name and Position | Roy Evans (PARTNER) |
| Authorized Official Contact | 4805101599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arizona Childrens Therapy Center Llc 8607 N 59th Ave Suite C-6 Glendale AZ 85302-5433 Ph: () - | Arizona Childrens Therapy Center Llc 7545 W Redbird Rd Peoria AZ 85383-6253 Ph: (480) 510-1599 |
| NPI Number | 1023432465 |
|---|---|
| Provider Enumeration Date | 02/05/2014 |
| Last Update Date | 04/19/2023 |
| Certification Date | 04/19/2023 |
| Medicare PECOS PAC ID | 1557580040 |
|---|---|
| Medicare Enrollment ID | O20140916000341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023432465 | NPI | - | NPPES |
| 868036 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (Arizona) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | AP5146 (Arizona) | Primary |
| Provider Name | Roy Lee Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578583209 PECOS PAC ID: 8426108481 Enrollment ID: I20140428000003 |
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