| Devereux Arizona | |
|
4000 N Central Ave Ste 100 Phoenix AZ 85012-3520 | |
| (602) 896-3106 | |
| Not Available |
| Full Name | Devereux Arizona |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 4000 N Central Ave Ste 100, Phoenix, Arizona |
| Authorized Official Name and Position | Yvette Jackson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4808890558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Devereux Arizona 11000 N Scottsdale Rd Ste 260 Scottsdale AZ 85254-5270 Ph: (480) 998-2920 | Devereux Arizona 4000 N Central Ave Ste 100 Phoenix AZ 85012-3520 Ph: (602) 896-3106 |
| NPI Number | 1306939368 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 03/28/2022 |
| Certification Date | 03/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306939368 | NPI | - | NPPES |
| 729634 | Other | AZ | AHCCCS ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | LC-003(8-01) (Arizona) | Primary |
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