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General NPI Number Information
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NPI Number | 1831551696
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Entity Type | Organization
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Legal Business Name | MARDEN PETRIE, PSYD, PLLC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 6592 N ORACLE RD
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City | TUCSON
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State | AZ
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Zip | 85704-5640
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Country | US
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Telephone | 520-488-4602
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Fax | 888-429-6085
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Provider Business Mailing Address
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Address Line | 11114 N FALLING RAIN RD
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City | ORO VALLEY
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State | AZ
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Zip | 85737-7321
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Country | US
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Telephone | 520-488-4602
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Fax | 888-429-6085
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MARDEN PETRIE
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Credential | PSYD
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Telephone | 520-488-4602
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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 | 4231
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License Number State | AZ
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