Healthcare Provider Details

I. General information

NPI: 1942240114
Provider Name (Legal Business Name): MICHAEL COFIELD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13760 N 93RD AVE STE 101
PEORIA AZ
85381-4201
US

IV. Provider business mailing address

PO BOX 56583
PHOENIX AZ
85072-3568
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-8420
  • Fax: 623-876-8524
Mailing address:
  • Phone: 623-544-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0789
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: