Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1400 | AZ |
Y | 103T00000X | Psychologist | 1400 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1400 | AZ |
N | 103TC1900X | Counseling Psychologist | 1400 | AZ |
N | 103TF0000X | Family Psychologist | 1400 | AZ |
N | 103TP2701X | Group Psychotherapist | 1400 | AZ |
NPI | 1497841332 |
---|---|
Provider Name | Mark E. Rohde |
First Address | Phoenix, AZ 85032-7196 |
Second Address | Phoenix, AZ 85032-7196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 06/05/2009 |