Healthcare Provider Details

I. General information

NPI: 1487570446
Provider Name (Legal Business Name): DEBRA LYNN NAMOKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W KORTSEN RD
CASA GRANDE AZ
85122-5910
US

IV. Provider business mailing address

824 N DATE # 3
MESA AZ
85201-4075
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-2111
  • Fax:
Mailing address:
  • Phone: 623-570-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4567938
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: