Provider Demographics
NPI:1851274393
Name:GISENDANER, JAMEY R (BHT)
Entity type:Individual
Prefix:
First Name:JAMEY
Middle Name:R
Last Name:GISENDANER
Suffix:
Gender:M
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 W NOVAK WAY
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2937
Mailing Address - Country:US
Mailing Address - Phone:702-764-0319
Mailing Address - Fax:
Practice Address - Street 1:2920 N 24TH AVE STE 260
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5961
Practice Address - Country:US
Practice Address - Phone:025-360-5516
Practice Address - Fax:602-532-7136
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician