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General NPI Number Information
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NPI Number | 1255636767
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Entity Type | Organization
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Legal Business Name | ARIZONA IN LOVE PLLC
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 11000 N SCOTTSDALE RD STE. 163
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6130
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Country | US
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Telephone | 480-922-5440
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Fax | 480-922-5445
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Provider Business Mailing Address
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Address Line | 21150 N TATUM BLVD #4012
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City | PHOENIX
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State | AZ
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Zip | 85050-4292
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Country | US
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Telephone | 480-371-4773
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. SCOT LIEPACK
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Credential | PHD
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Telephone | 480-371-4773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4061
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License Number State | AZ
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