Provider Demographics
NPI:1306335146
Name:SHOBIN, MARK (EDD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SHOBIN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14887 N 103RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8511
Mailing Address - Country:US
Mailing Address - Phone:978-884-6295
Mailing Address - Fax:
Practice Address - Street 1:14887 N 103RD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8511
Practice Address - Country:US
Practice Address - Phone:978-884-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005232103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling