Provider Demographics
NPI:1871132407
Name:ROMNEY, MISTY RAYNE
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:RAYNE
Last Name:ROMNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 E LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2862
Mailing Address - Country:US
Mailing Address - Phone:480-353-0068
Mailing Address - Fax:
Practice Address - Street 1:3630 E LESLIE DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2862
Practice Address - Country:US
Practice Address - Phone:480-353-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional