Healthcare Provider Details

I. General information

NPI: 1851993786
Provider Name (Legal Business Name): SPENSER HUGHES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 N 70TH ST APT 3073
SCOTTSDALE AZ
85251-6374
US

IV. Provider business mailing address

2929 N 70TH ST APT 3073
SCOTTSDALE AZ
85251-6374
US

V. Phone/Fax

Practice location:
  • Phone: 310-701-7402
  • Fax:
Mailing address:
  • Phone: 310-701-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5308
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5308
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5308
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number5308
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: