Healthcare Provider Details

I. General information

NPI: 1801919840
Provider Name (Legal Business Name): TYRA MARIA RIPLEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 W CHOLLA ST
PHOENIX AZ
85029-4113
US

IV. Provider business mailing address

6302 N 40TH DR
PHOENIX AZ
85019-1428
US

V. Phone/Fax

Practice location:
  • Phone: 602-896-5413
  • Fax: 602-896-5420
Mailing address:
  • Phone: 602-242-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: