Individual
DR. STACEY HALVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH D
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-0414
(602) 933-4252
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1813
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
37678
TX
103T00000X
Psychologist
Primary
4950
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37678
LICENSE
TX
Enumeration date
01/22/2018
Last updated
04/24/2018
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