MEDICARE: DAVID CHARLES SEATON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3014	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY-003014	OTHER	AZ	AZ STATE BOARD OF PSYCHOLOGIST EXAMINERS

General Provider Information

NPI Number	:	1205959186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CHARLES SEATON PH.D.

Provider Business Mailing Address
First Line	:	4545 N 36TH ST STE 115
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3473
Country	:	US
Telephone Number	:	602-956-2936
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 N 36TH ST STE 115
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3473
Country	:	US
Telephone Number	:	602-956-2936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	11/14/2019

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