Basic Information
| Provider Information | |||||||||
| NPI: | 1184000317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WITHINSIGHT PSYCHOLOGICAL SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9920 S RUAL ROAD | ||||||||
| Address2: | SUITE 108-31 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852844100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806509144 | ||||||||
| FaxNumber: | 4802642763 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 N DOBSON RD | ||||||||
| Address2: | SUITE D3 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852249601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806509144 | ||||||||
| FaxNumber: | 4802642763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2015 | ||||||||
| LastUpdateDate: | 08/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4806509144 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1939 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 1689618266 | 01 | AZ | TYPE 1 NPI NUMBER | OTHER |