Healthcare Provider Details

I. General information

NPI: 1154483881
Provider Name (Legal Business Name): DOUGLAS WILLIAM TREESE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 W CHANDLER BLVD SUITE 13
CHANDLER AZ
85224-5207
US

IV. Provider business mailing address

1137 W 12TH ST
TEMPE AZ
85281-5364
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-7857
  • Fax: 480-821-7886
Mailing address:
  • Phone: 480-968-8627
  • Fax: 480-821-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: