Provider Demographics
NPI:1437305489
Name:MACKEY-BOYD, MARISA BETH (MED)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:BETH
Last Name:MACKEY-BOYD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8531 E SAN JACINTO DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2564
Mailing Address - Country:US
Mailing Address - Phone:253-307-9749
Mailing Address - Fax:
Practice Address - Street 1:8531 E SAN JACINTO DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2564
Practice Address - Country:US
Practice Address - Phone:253-307-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4051312103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool