Healthcare Provider Details

I. General information

NPI: 1023216645
Provider Name (Legal Business Name): CONNIE MARIE HUNT PH.D., DAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE MARIE COWLES

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

PO BOX 31001-0698
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1200
  • Fax: 602-263-1631
Mailing address:
  • Phone: 602-263-1200
  • Fax: 602-263-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1116
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number4622
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: