Organization
PRONGHORN PSYCHIATRY
Active
Organization
PRONGHORN PSYCHIATRY
Active
Other names
Stoneridge Centers for Brain and Addiction Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH LETENDRE (CHIEF EXECUTIVE OFFICER)
(928) 583-7799
Entity
Organization
Contact information
Practice address
5940 E. COPPER HILL DR, SUITE E, PRESCOTT VALLEY, AZ 86314
(928) 583-7799
(928) 583-7891
Mailing address
5940 E. COPPER HILL DR, SUITE E, PRESCOTT VALLEY, AZ 86314
(928) 583-7799
(928) 583-7891
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
OTC8169
AZ
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
05/23/2018
Last updated
11/15/2024
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