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General NPI Number Information
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NPI Number | 1700070489
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Entity Type | Individual
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Provider Name | JOHN DAVID MATHER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 1084 SAN TAN HILLS DR
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City | QUEEN CREEK
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State | AZ
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Zip | 85243-3489
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Country | US
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Telephone | 480-888-7520
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2850
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City | FLORENCE
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State | AZ
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Zip | 85232-2850
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Country | US
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Telephone | 520-866-3500
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 3313826
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 4056
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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 | 4056
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License Number State | AZ
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