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General NPI Number Information
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NPI Number | 1952205734
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Entity Type | Organization
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Legal Business Name | STATE 48 PSYCHIATRY PLLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 501 S MAIN ST
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City | SNOWFLAKE
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State | AZ
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Zip | 85937-5251
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Country | US
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Telephone | 480-586-0035
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Fax |
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Provider Business Mailing Address
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Address Line | 1745 W WESTERN DOVE DR
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City | SNOWFLAKE
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State | AZ
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Zip | 85937-6185
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Country | US
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Telephone | 480-586-0035
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK SKOUSEN
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Credential | PMHNP
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Telephone | 480-586-0035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | NULL
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