Provider Demographics
NPI:1447474440
Name:PECAUT, LINNUS S (PHD)
Entity type:Individual
Prefix:
First Name:LINNUS
Middle Name:S
Last Name:PECAUT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40204 N 110TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-4963
Mailing Address - Country:US
Mailing Address - Phone:480-595-0731
Mailing Address - Fax:480-595-0305
Practice Address - Street 1:4222 E CAMELBACK RD
Practice Address - Street 2:230H
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2745
Practice Address - Country:US
Practice Address - Phone:602-852-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical