Provider Demographics
NPI:1316108665
Name:GEEN, THOMAS RUSSELL (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RUSSELL
Last Name:GEEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 E VERBENA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6507
Mailing Address - Country:US
Mailing Address - Phone:480-516-9778
Mailing Address - Fax:
Practice Address - Street 1:4411 S RURAL RD STE 201
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7072
Practice Address - Country:US
Practice Address - Phone:612-930-2202
Practice Address - Fax:602-442-4085
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3572103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic