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General NPI Number Information
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NPI Number | 1881079184
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Entity Type | Organization
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Legal Business Name | MENTAL EDGE NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 16838 E PALISADES BLVD SUITE C153
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-3786
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Country | US
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Telephone | 602-510-9217
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | PHOENIX
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State | AZ
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Zip | 85001-0967
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | JOHN W DENBOER
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Credential | PH.D.
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Telephone | 602-510-9217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 4026
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License Number State | AZ
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