Healthcare Provider Details

I. General information

NPI: 1952205734
Provider Name (Legal Business Name): STATE 48 PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S MAIN ST
SNOWFLAKE AZ
85937-5251
US

IV. Provider business mailing address

1745 W WESTERN DOVE DR
SNOWFLAKE AZ
85937-6185
US

V. Phone/Fax

Practice location:
  • Phone: 480-586-0035
  • Fax:
Mailing address:
  • Phone: 480-586-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK SKOUSEN
Title or Position: OWNER
Credential: PMHNP
Phone: 480-586-0035