Individual
MARILYN K MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
920 N CITADEL AVE, TUCSON, AZ 85748-2730
(520) 296-2751
Mailing address
920 N CITADEL AVE, TUCSON, AZ 85748-2730
(520) 296-2751
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1774
AZ
103TS0200X
School Psychologist
1774
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054742
—
AZ
Enumeration date
01/02/2007
Last updated
07/20/2012
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