Healthcare Provider Details

I. General information

NPI: 1700939634
Provider Name (Legal Business Name): DAVID STANLEY HOUSER M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 N 39TH AVE
PHOENIX AZ
85051-3324
US

IV. Provider business mailing address

2649 E PERSHING AVE
PHOENIX AZ
85032-5931
US

V. Phone/Fax

Practice location:
  • Phone: 602-347-2100
  • Fax:
Mailing address:
  • Phone: 602-971-3598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1531844
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: