Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1008 | NC |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 3463 | AZ |
NPI | 1013936228 |
---|---|
Provider Name | Alan Lee Ogus |
First Address | Mesa, AZ 85207 |
Second Address | Phoenix, AZ 85013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
787624 | AHCCS PROVIDER NUMBER (01) | AZ |