Healthcare Provider Details

I. General information

NPI: 1568655850
Provider Name (Legal Business Name): STEPHEN MAXWELL MYLES PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD SUITE 401
PHOENIX AZ
85013-4419
US

IV. Provider business mailing address

56765 FILE
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3473
  • Fax: 602-406-4406
Mailing address:
  • Phone: 602-406-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3894
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: