Healthcare Provider Details

I. General information

NPI: 1912230178
Provider Name (Legal Business Name): MOZELLE BARR MARTIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date: 01/24/2018
Reactivation Date: 09/25/2020

III. Provider practice location address

3734 W. VISTA AVE.
PHOENIX AZ
85051
US

IV. Provider business mailing address

504 S. 5TH AVE. #1427
SAFFORD AZ
85546
US

V. Phone/Fax

Practice location:
  • Phone: 623-850-8198
  • Fax: 888-306-2742
Mailing address:
  • Phone: 928-985-5050
  • Fax: 602-733-6538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberP0214763
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number00012
License Number StateZZ
# 7
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: