Individual
MR. SCOT LIEPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
6601 W THOMAS RD, PHOENIX, AZ 85033-5700
(602) 243-7277
(623) 247-9742
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
4061
AZ
103T00000X
Psychologist
PSY722
HI
103TC0700X
Clinical Psychologist
Primary
PSY1543
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
756791
—
AZ
Enumeration date
07/16/2006
Last updated
01/29/2019
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