Healthcare Provider Details

I. General information

NPI: 1780629923
Provider Name (Legal Business Name): HEARTS AND MINDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 N 16TH ST SUITE G
PHOENIX AZ
85020-5253
US

IV. Provider business mailing address

7220 N 16TH ST SUITE G
PHOENIX AZ
85020-5253
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-0480
  • Fax: 602-944-0482
Mailing address:
  • Phone: 602-944-0480
  • Fax: 602-944-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPHD856
License Number StateAZ

VIII. Authorized Official

Name: DR. MARC S. WALTER
Title or Position: PRESIDENT
Credential: PHD
Phone: 602-944-0480