Provider Demographics
NPI:1023401965
Name:TEMPE PSYCHIATRY
Entity type:Organization
Organization Name:TEMPE PSYCHIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-945-2558
Mailing Address - Street 1:455 S 48TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2302
Mailing Address - Country:US
Mailing Address - Phone:480-945-2558
Mailing Address - Fax:480-945-2354
Practice Address - Street 1:455 S 48TH ST STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2302
Practice Address - Country:US
Practice Address - Phone:480-945-2558
Practice Address - Fax:480-945-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health