Provider Demographics
NPI:1124146519
Name:FERRICK, MARSHA ELAINE (PHD, BCC)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:ELAINE
Last Name:FERRICK
Suffix:
Gender:F
Credentials:PHD, BCC
Other - Prefix:DR
Other - First Name:MARSHA
Other - Middle Name:ELAINE
Other - Last Name:FERRICK HEIDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, BCC
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:BLACK CANYON CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85324-0203
Mailing Address - Country:US
Mailing Address - Phone:216-780-5068
Mailing Address - Fax:
Practice Address - Street 1:34406 N 27TH DR
Practice Address - Street 2:STE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6079
Practice Address - Country:US
Practice Address - Phone:216-780-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical