Healthcare Provider Details

I. General information

NPI: 1669029104
Provider Name (Legal Business Name): ERIC SUEDMEYER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 S DOBSON RD
MESA AZ
85202-6488
US

IV. Provider business mailing address

2266 S DOBSON RD
MESA AZ
85202-6488
US

V. Phone/Fax

Practice location:
  • Phone: 602-935-5447
  • Fax:
Mailing address:
  • Phone: 602-935-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5141
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: