Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1116 | OR |
Y | 103T00000X | Psychologist | 1116 | OR |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4622 |
NPI | 1023216645 |
---|---|
Provider Name | Connie Marie Hunt |
First Address | Pasadena, CA 91110-0001 |
Second Address | Phoenix, AZ 85016-5319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273855 | (05) | OR |