Healthcare Provider Details

I. General information

NPI: 1336334440
Provider Name (Legal Business Name): MARK S. MAGIER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 N TATUM BLVD SUITE 3031
PHOENIX AZ
85028-1614
US

IV. Provider business mailing address

11811 N TATUM BLVD SUITE 3031
PHOENIX AZ
85028-1614
US

V. Phone/Fax

Practice location:
  • Phone: 480-703-6714
  • Fax: 480-302-7814
Mailing address:
  • Phone: 480-703-6714
  • Fax: 480-302-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4010
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4322
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: