Individual
PAUL N BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.S.
Contact information
Practice address
20740 S ELLSWORTH RD, QUEEN CREEK, AZ 85242-9058
(480) 987-5900
Mailing address
20740 S ELLSWORTH RD, QUEEN CREEK, AZ 85242-9058
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4057079
AZ
Other
Enumeration date
07/18/2008
Last updated
07/18/2008
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