Healthcare Provider Details

I. General information

NPI: 1316108665
Provider Name (Legal Business Name): THOMAS RUSSELL GEEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 S RURAL RD STE 201
TEMPE AZ
85282-7072
US

IV. Provider business mailing address

3508 E VERBENA DR
PHOENIX AZ
85044-6507
US

V. Phone/Fax

Practice location:
  • Phone: 612-930-2202
  • Fax: 602-442-4085
Mailing address:
  • Phone: 480-516-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3572
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3572
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: