Provider Demographics
NPI:1093239048
Name:KHATAMI, EMMA HOPE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:HOPE
Last Name:KHATAMI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:HOPE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2108 E THOMAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-0008
Mailing Address - Country:US
Mailing Address - Phone:602-933-3124
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD BLDG 4TH
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-933-0414
Practice Address - Fax:602-933-4252
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005004103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ414481Medicaid