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Clinical Neuropsychologist

Tucson, Arizona

Provider NPI: 1467544718

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
5363 E PIMA ST STE 100  TUCSON, AZ 85712 US
Tel: 520-690-6443  Fax: 520-323-1336

Business Mailing Address:
5363 E PIMA ST STE 100  TUCSON, AZ 85712 US
Tel: 520-690-6443  Fax: 520-323-1336

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
X103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
X103T00000XBehavioral Health & Social Service Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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