Provider Demographics
NPI:1144214289
Name:TREEGOOB, MARK RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:TREEGOOB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:19420 N 59TH AVE
Mailing Address - Street 2:STE C269
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-2800
Mailing Address - Country:US
Mailing Address - Phone:602-375-2868
Mailing Address - Fax:602-375-3516
Practice Address - Street 1:19420 N 59TH AVE
Practice Address - Street 2:STE C269
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-2800
Practice Address - Country:US
Practice Address - Phone:602-843-5484
Practice Address - Fax:602-843-5498
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ629103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ731358Medicaid
AZPHD629Medicare ID - Type UnspecifiedPSYCHOLOGIST