Healthcare Provider Details

I. General information

NPI: 1003850892
Provider Name (Legal Business Name): DEBORAH DYER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH BUROWS PHD

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S. FOREST AVE SSV 334
TEMPE AZ
85287
US

IV. Provider business mailing address

PO BOX 168007
IRVING TX
75016-8007
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-6147
  • Fax: 480-965-3426
Mailing address:
  • Phone: 469-735-4555
  • Fax: 469-735-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3513
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: