Healthcare Provider Details

I. General information

NPI: 1215338165
Provider Name (Legal Business Name): DEPRESSION RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14362 N FRANK LLOYD WRIGHT BLVD SUITE B111
SCOTTSDALE AZ
85260-8846
US

IV. Provider business mailing address

1232 E BROADWAY RD SUITE 205
TEMPE AZ
85282-1511
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-5536
  • Fax:
Mailing address:
  • Phone: 480-874-7014
  • Fax: 480-874-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. MARK MURPHY
Title or Position: PRESIDENT
Credential: MD
Phone: 480-874-7014