MEDICARE: DR. KONSTANTINOS D. THOMOPOULOS PSYD

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	4495	AZ
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	4495	AZ
3	103TA0700X	Adult Development & Aging Psychologist	4495	AZ
4	103TB0200X	Cognitive & Behavioral Psychologist	4495	AZ
5	103TC0700X	Clinical Psychologist	4495	AZ
6	103TC2200X	Clinical Child & Adolescent Psychologist	4495	AZ
7	103TF0000X	Family Psychologist	4495	AZ
8	103TF0200X	Forensic Psychologist	4495	AZ
9	103TH0004X	Health Psychologist	4495	AZ
10	103TP2701X	Group Psychotherapy Psychologist	4495	AZ
11	103TR0400X	Rehabilitation Psychologist	4495	AZ

General Provider Information

NPI Number	:	1801206115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KONSTANTINOS D. THOMOPOULOS PSYD

Provider Business Mailing Address
First Line	:	33755 N SCOTTSDALE RD
Second Line	:	SUITE J-105
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85266-1567
Country	:	US
Telephone Number	:	480-575-5700
Fax Number	:	866-307-0007

Provider Business Practice Location Address
First Line	:	33755 N SCOTTSDALE RD
Second Line	:	SUITE J-105
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85266-1567
Country	:	US
Telephone Number	:	480-575-5700
Fax Number	:	866-307-0007

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

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	05/08/2014

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Directions to “ DR. KONSTANTINOS D. THOMOPOULOS PSYD” Practice Location

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