Provider Demographics
NPI:1346363140
Name:ARCHER, MARLO J (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLO
Middle Name:J
Last Name:ARCHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARLO
Other - Middle Name:J
Other - Last Name:STREHLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1250 E BASELINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1404
Mailing Address - Country:US
Mailing Address - Phone:480-705-5007
Mailing Address - Fax:
Practice Address - Street 1:1250 E BASELINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1404
Practice Address - Country:US
Practice Address - Phone:480-705-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3300103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily