MEDICARE: HEARTS AND MINDS, INC.

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	103G00000X	Clinical Neuropsychologist	PHD856	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780629923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTS AND MINDS, INC.

Provider Business Mailing Address
First Line	:	7220 N 16TH ST
Second Line	:	SUITE G
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5253
Country	:	US
Telephone Number	:	602-944-0480
Fax Number	:	602-944-0482

Provider Business Practice Location Address
First Line	:	7220 N 16TH ST
Second Line	:	SUITE G
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5253
Country	:	US
Telephone Number	:	602-944-0480
Fax Number	:	602-944-0482

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARC S. WALTER
Credential	:	PHD
Telephone Number	:	602-944-0480

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	02/13/2013

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Directions to “HEARTS AND MINDS, INC. ” Practice Location

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