Healthcare Provider Details

I. General information

NPI: 1538086616
Provider Name (Legal Business Name): JOHN ROBERT MARCUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 S RIVER PKWY
TEMPE AZ
85284-2615
US

IV. Provider business mailing address

8350 S RIVER PKWY
TEMPE AZ
85284-2615
US

V. Phone/Fax

Practice location:
  • Phone: 800-345-1036
  • Fax:
Mailing address:
  • Phone: 800-345-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License NumberS008004
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: