=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477066561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAINVIEW CLINICAL PSYCHOLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2017
-----------------------------------------------------
Last Update Date | 08/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14300 N NORTHSIGHT BLVD STE 215
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-3677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-280-6618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3217 E SHEA BLVD STE 168
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85028-3381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-280-6618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEUROPSYCHOLOGIST
-----------------------------------------------------
Name | DR. KRISTI LYNN HUSK
-----------------------------------------------------
Credential | PSY.D., CBIS
-----------------------------------------------------
Telephone | 480-280-6618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 3959
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------