Provider Demographics
NPI:1336334440
Name:MAGIER, MARK S (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:MAGIER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 N TATUM BLVD
Mailing Address - Street 2:SUITE 3031
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1614
Mailing Address - Country:US
Mailing Address - Phone:480-703-6714
Mailing Address - Fax:480-302-7814
Practice Address - Street 1:11811 N TATUM BLVD
Practice Address - Street 2:SUITE 3031
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1614
Practice Address - Country:US
Practice Address - Phone:480-703-6714
Practice Address - Fax:480-302-7814
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4322103TC0700X
AZ103TS0200X
AZ4010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY4322OtherLICENSED PSYCHOLOGIST