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General NPI Number Information
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NPI Number | 1831825348
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Entity Type | Individual
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Provider Name | JOHN MANSOOR PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 337 E CORONADO RD STE 201
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City | PHOENIX
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State | AZ
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Zip | 85004-1583
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Country | US
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Telephone | 480-712-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 701 W RIO SALADO PKWY APT 3012
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City | TEMPE
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State | AZ
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Zip | 85281-6285
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Country | US
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Telephone | 480-522-8636
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-005528
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License Number State | AZ
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