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NPI Code Detail

MEDICARE: WILLIE ROGER COUNTS

MEDICARE: WILLIE ROGER COUNTS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist648AZ

General Provider Information

NPI Number : 1023292737
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIE ROGER COUNTS
Provider Business Mailing Address
First Line : 3052 E DESERT BROOM WAY
Second Line :
City : PHOENIX
State : AZ
Zip : 85048-8314
Country : US
Telephone Number : 480-227-1665
Fax Number :
Provider Business Practice Location Address
First Line : 3052 E DESERT BROOM WAY
Second Line :
City : PHOENIX
State : AZ
Zip : 85048-8314
Country : US
Telephone Number : 480-227-1665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2007
Last Update Date : 12/18/2007

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Directions to “ WILLIE ROGER COUNTS ” Practice Location

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