NPIMap

Organization Active NPI

Pronghorn Psychiatry

Doing business as Stoneridge Centers for Brain and Addiction Treatment

  • Adult Mental Health Clinic/Center
  • Prescott Valley, AZ
National Provider Identifier
1700377983
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
OTC8169 Issued in AZ
Legal business name
PRONGHORN PSYCHIATRY
Doing business as
Stoneridge Centers for Brain and Addiction Treatment
Practice address
5940 E. Copper Hill Dr
Suite E
Prescott Valley, AZ 86314
Phone
(928) 583-7799
Fax
(928) 583-7891
NPI assigned
May 23, 2018
Last updated
Nov 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Authorized official

Name
Joseph Letendre
Title
Chief Executive Officer
Phone
(928) 583-7799

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X OTC8169 AZ Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

5940 E. Copper Hill Dr
Suite E
Prescott Valley, AZ 86314

Mailing address

5940 E. Copper Hill Dr
Suite E
Prescott Valley, AZ 86314
Phone (928) 583-7799

Other names 1

  • Stoneridge Centers for Brain and Addiction Treatment Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pronghorn Psychiatry3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1700377983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 E. COPPER HILL DR",
            "address_2": "SUITE E",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "86314",
            "telephone_number": "928-583-7799",
            "fax_number": "928-583-7891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5940 E. COPPER HILL DR",
            "address_2": "SUITE E",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "86314",
            "telephone_number": "928-583-7799",
            "fax_number": "928-583-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRONGHORN PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-23",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "LETENDRE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "928-583-7799"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "AZ",
            "license": "OTC8169",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stoneridge Centers for Brain and Addiction Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.