Provider Demographics
NPI:1831596915
Name:AZ CHILD AND FAMILY PSYCHOLOGICAL SERVICES, PLLC.
Entity type:Organization
Organization Name:AZ CHILD AND FAMILY PSYCHOLOGICAL SERVICES, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAJOLET-ECKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-515-2445
Mailing Address - Street 1:3048 E. BASELINE ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204
Mailing Address - Country:US
Mailing Address - Phone:323-457-8543
Mailing Address - Fax:602-293-3271
Practice Address - Street 1:3048 E BASELINE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7286
Practice Address - Country:US
Practice Address - Phone:323-457-8543
Practice Address - Fax:602-293-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43702600Medicaid