Healthcare Provider Details

I. General information

NPI: 1497487912
Provider Name (Legal Business Name): PSYCHOLOGY PRACTICE OF JUDITH RAND PHD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 S DOBSON RD STE 106
MESA AZ
85202-5662
US

IV. Provider business mailing address

1845 S DOBSON RD STE 106
MESA AZ
85202-5662
US

V. Phone/Fax

Practice location:
  • Phone: 480-466-7010
  • Fax: 480-219-5254
Mailing address:
  • Phone: 480-466-7010
  • Fax: 480-219-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JUDITH ELLEN RAND
Title or Position: OWNER
Credential: PHD
Phone: 480-466-7010