Basic Information
| Provider Information | |||||||||
| NPI: | 1497042337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANZA | ||||||||
| FirstName: | GUSTAVO | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8607 S 22ND PL | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850428145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024301458 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2524 E INDIAN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850166737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133855100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2011 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY-004503 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | PSY-004503 | AZ | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TF0000X | PSY-004503 | AZ | N | Behavioral Health & Social Service Providers | Psychologist | Family | 103TF0200X | PSY-004503 | AZ | N | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No ID Information.