| Organization Name: | AMY CATHERINE JACKSON-GROSSBLAT |
| NPI Number: | 1265860316 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMY CATHERINE JACKSON-GROSSBLAT (LICENSED PSYCHOLOGIST) |
| Mailing Address: | 5646 E Morning Vista Ln Cave Creek |
| State: | AZ US |
| Postal Code: | 853313446 |
| Phone Number: | 2692080002 |
| Fax Number: | 4802752598 |
| NPI Enumeration Date: | 10/29/2013 |
| NPI Last Update Date: | 11/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |