Healthcare Provider Details

I. General information

NPI: 1346363140
Provider Name (Legal Business Name): MARLO J ARCHER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLO J STREHLOW PH.D.

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E BASELINE RD SUITE 102
TEMPE AZ
85283-1404
US

IV. Provider business mailing address

1250 E BASELINE RD SUITE 102
TEMPE AZ
85283-1404
US

V. Phone/Fax

Practice location:
  • Phone: 480-705-5007
  • Fax:
Mailing address:
  • Phone: 480-705-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3300
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: