Professional Psychology Associates, PC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

BH934 Issued in AZ

Legal business name

PROFESSIONAL PSYCHOLOGY ASSOCIATES, PC

Doing business as

Center for Lifestyle Change

Practice address

4222 E Camelback Rd
Suite H230
Phoenix, AZ 85018-2745

Phone

(602) 852-0911

Fax

(602) 852-0632

NPI assigned

May 1, 2007

Organization subpart

Yes

Parent organization

PROFESSIONAL PSYCHLOGY ASSOCIATES, PCAs reported in NPPES

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

Authorized official

Name

Dr. Phillip D Lett, PHDNPI 1710935515

Title

Administrator/President

Phone

(602) 852-0911

Specialties & licenses 1

Addresses

Other names 1

• Center for Lifestyle Change Doing business as

Tax ID family

Professional Psychology Associates PC2 organizations share this tax ID, including this one

Part of

Professional Psychology Associates PC

Other organizations with this tax ID 1

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

• Professional Psychology Associates PC

  • Rehabilitation Psychologist
  • Phoenix, AZ
  • NPI 1821003419
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Phillip D Lett, PH.D.

  • Rehabilitation Psychologist
  • Phoenix, AZ
  • NPI 1710935515
  NPD (past) Authorized official

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1801016878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4222 E CAMELBACK ROAD",
            "address_2": "SUITE H230",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182787",
            "telephone_number": "602-852-0911",
            "fax_number": "602-852-0632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4222 E CAMELBACK RD",
            "address_2": "SUITE H230",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182745",
            "telephone_number": "602-852-0911",
            "fax_number": "602-852-0632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PSYCHOLOGY ASSOCIATES, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROFESSIONAL PSYCHLOGY ASSOCIATES, PC",
        "enumeration_date": "2007-05-01",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "LETT",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR/PRESIDENT",
        "authorized_official_telephone_number": "602-852-0911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "AZ",
            "license": "BH934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Lifestyle Change",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Progressive Family Home Care
• Progressive General Anesthetics, LLC
• Progressive Living LLC

• Substance Use Disorder Rehabilitation Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; 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.