MEDICARE: MARK E. ROHDE 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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	1400	AZ
2	103T00000X	Psychologist	1400	AZ
3	103TC1900X	Counseling Psychologist	1400	AZ
4	103TP2701X	Group Psychotherapy Psychologist	1400	AZ
5	103TF0000X	Family Psychologist	1400	AZ

General Provider Information

NPI Number	:	1497841332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK E. ROHDE PH.D.

Provider Business Mailing Address
First Line	:	3040 E CACTUS RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7196
Country	:	US
Telephone Number	:	602-494-1515
Fax Number	:	602-494-3131

Provider Business Practice Location Address
First Line	:	3040 E CACTUS RD
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7196
Country	:	US
Telephone Number	:	602-494-1515
Fax Number	:	602-494-3131

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	05/06/2009

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