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General NPI Number Information
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NPI Number | 1265590418
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Entity Type | Individual
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Provider Name | MARYANN BELTRAN THIRAKUL PSYD.
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 2266 S. DOBSON RD. SUITE 200
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City | MESA
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State | AZ
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Zip | 85202
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Country | US
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Telephone | 480-775-5154
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Fax | 480-744-2726
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Provider Business Mailing Address
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Address Line | 1830 S ALMA SCHOOL RD STE 104
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City | MESA
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State | AZ
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Zip | 85210-3086
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Country | US
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Telephone | 480-344-7088
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Fax | 480-744-2726
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3783
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3783
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3783
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License Number State | AZ
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