| Performance Fallon Inc | |
|
143 E Merritt St Prescott AZ 86301-2028 | |
| (928) 460-4443 | |
| (928) 460-4443 |
| Full Name | Performance Fallon Inc |
|---|---|
| Speciality | Psychologist |
| Location | 143 E Merritt St, Prescott, Arizona |
| Authorized Official Name and Position | Daniel T Fallon (PRESIDENT) |
| Authorized Official Contact | 9284604443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Performance Fallon Inc 261 Jacob Ln Prescott AZ 86303-5844 Ph: (847) 323-2636 | Performance Fallon Inc 143 E Merritt St Prescott AZ 86301-2028 Ph: (928) 460-4443 |
| NPI Number | 1851783187 |
|---|---|
| Provider Enumeration Date | 02/24/2015 |
| Last Update Date | 02/24/2015 |
| Medicare PECOS PAC ID | 6103146022 |
|---|---|
| Medicare Enrollment ID | O20150518000061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851783187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 4578 (Arizona) | Primary |
| Provider Name | Daniel Thomas Fallon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952386708 PECOS PAC ID: 0042409120 Enrollment ID: I20150518001612 |
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