Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3513 | AZ |
Y | 103TC0700X | Clinical Psychologist | 3513 | AZ |
NPI | 1003850892 |
---|---|
Provider Name | Deborah Dyer |
First Address | Irving, TX 75016-8007 |
Second Address | Tempe, AZ 85287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134426 | (05) | AZ |