Neurodiversity Education Research Center

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

NEURODIVERSITY EDUCATION RESEARCH CENTER

Practice address

1375 E Broadway Rd
Phoenix, AZ 85040-2305

Phone

(602) 832-4708

NPI assigned

Jun 26, 2024

Last updated

Jun 26, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth Mims

Title

Ceo

Phone

(480) 939-6013

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1093550535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 E GRANT ST STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850042750",
            "telephone_number": "602-832-4708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 E BROADWAY RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850402305",
            "telephone_number": "602-832-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURODIVERSITY EDUCATION RESEARCH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "MIMS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-939-6013"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Developmental Disabilities Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.