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General NPI Number Information
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NPI Number | 1902093164
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Entity Type | Organization
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Legal Business Name | RISA E. NEWELL, PH.D., L.L.C.
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 11110 N TATUM BLVD SUITE 103
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City | PHOENIX
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State | AZ
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Zip | 85028-1607
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Country | US
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Telephone | 602-478-1477
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Fax | 602-443-0400
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Provider Business Mailing Address
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Address Line | 11110 N TATUM BLVD SUITE 103
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City | PHOENIX
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State | AZ
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Zip | 85028-1607
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Country | US
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Telephone | 602-478-1477
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Fax | 602-443-0400
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARISA EUBANK NEWELL
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Credential | PH.D.
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Telephone | 602-478-1477
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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 | 3330
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License Number State | AZ
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