Healthcare Provider Details

I. General information

NPI: 1336328806
Provider Name (Legal Business Name): A POSITIVE OUTCOME NEUROPSYCHOLOGY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 N 16TH ST SUITE 222
PHOENIX AZ
85020-5251
US

IV. Provider business mailing address

7227 N 16TH ST SUITE 222
PHOENIX AZ
85020-5251
US

V. Phone/Fax

Practice location:
  • Phone: 623-512-8021
  • Fax: 623-825-6784
Mailing address:
  • Phone: 623-512-8021
  • Fax: 623-825-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3573
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3573
License Number StateAZ

VIII. Authorized Official

Name: DR. TRACY LYNN THOMAS
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 623-512-8021