Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3631 | AZ |
Y | 103T00000X | Psychologist | 3631 | AZ |
NPI | 1013930437 |
---|---|
Provider Name | Dr. Connie S. Pyburn Ph.d Pllc |
First Address | Tempe, AZ 85283-3717 |
Second Address | Tempe, AZ 85283-3717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 10/05/2017 |