Healthcare Provider Details

I. General information

NPI: 1801206115
Provider Name (Legal Business Name): KONSTANTINOS D. THOMOPOULOS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33755 N SCOTTSDALE RD SUITE J-105
SCOTTSDALE AZ
85266-1567
US

IV. Provider business mailing address

33755 N SCOTTSDALE RD SUITE J-105
SCOTTSDALE AZ
85266-1567
US

V. Phone/Fax

Practice location:
  • Phone: 480-575-5700
  • Fax: 866-307-0007
Mailing address:
  • Phone: 480-575-5700
  • Fax: 866-307-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4495
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number4495
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4495
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4495
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4495
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4495
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4495
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number4495
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4495
License Number StateAZ
# 10
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number4495
License Number StateAZ
# 11
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number4495
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: