Healthcare Provider Details

I. General information

NPI: 1407049950
Provider Name (Legal Business Name): MARJEAN SPAYER PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2007
Last Update Date: 08/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HILLRISE DR SUITE B-2
LAS CRUCES NM
88011-4897
US

IV. Provider business mailing address

PO BOX 13242
LAS CRUCES NM
88013-3242
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-4800
  • Fax: 505-521-6399
Mailing address:
  • Phone: 505-521-4800
  • Fax: 505-521-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number577
License Number StateNM

VIII. Authorized Official

Name: DR. MARJEAN SPAYER
Title or Position: PRESIDENT
Credential: PH D
Phone: 505-521-4800