Healthcare Provider Details

I. General information

NPI: 1497841332
Provider Name (Legal Business Name): MARK E. ROHDE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 E CACTUS RD SUITE A
PHOENIX AZ
85032-7196
US

IV. Provider business mailing address

3040 E CACTUS RD SUITE A
PHOENIX AZ
85032-7196
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-1515
  • Fax: 602-494-3131
Mailing address:
  • Phone: 602-494-1515
  • Fax: 602-494-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1400
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1400
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1400
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1400
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1400
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: