Provider Demographics
NPI:1437371168
Name:DETZEL, RICHARD (PHD SCHOOL PSYCHOLO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:DETZEL
Suffix:
Gender:M
Credentials:PHD SCHOOL PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W BIRCHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-6356
Mailing Address - Country:US
Mailing Address - Phone:602-290-2858
Mailing Address - Fax:
Practice Address - Street 1:81 W BIRCHWOOD PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-6356
Practice Address - Country:US
Practice Address - Phone:602-290-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool