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General NPI Number Information
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NPI Number | 1407049950
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Entity Type | Organization
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Legal Business Name | MARJEAN SPAYER PHD PC
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Dates
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Enumeration Date | 08/18/2007
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Last Update Date | 08/18/2007
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Provider Practice Location Address
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Address Line | 3003 HILLRISE DR SUITE B-2
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City | LAS CRUCES
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State | NM
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Zip | 88011-4897
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Country | US
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Telephone | 505-521-4800
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Fax | 505-521-6399
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Provider Business Mailing Address
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Address Line | PO BOX 13242
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City | LAS CRUCES
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State | NM
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Zip | 88013-3242
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Country | US
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Telephone | 505-521-4800
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Fax | 505-521-6399
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARJEAN SPAYER
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Credential | PH D
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Telephone | 505-521-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 577
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License Number State | NM
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