Organization
PERFORMANCE FALLON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL T FALLON PSY.D. (PRESIDENT)
(928) 460-4443
Entity
Organization
Contact information
Practice address
143 E MERRITT ST, PRESCOTT, AZ 86301-2028
(928) 460-4443
(928) 460-4443
Mailing address
261 JACOB LN, PRESCOTT, AZ 86303-5844
(847) 323-2636
(928) 460-4443
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4578
AZ
Other
Enumeration date
02/24/2015
Last updated
02/24/2015
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