Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1083620561 |
---|---|
Provider Name | Dr. Stephen Clay Neal JR. |
First Address | Phoenix, AZ 85033-1861 |
Second Address | Avondale, AZ 85323-2264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 25/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
955073 | (02) | AZ |