Provider Demographics
NPI:1497841332
Name:ROHDE, MARK E (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:ROHDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 E CACTUS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7196
Mailing Address - Country:US
Mailing Address - Phone:602-494-1515
Mailing Address - Fax:602-494-3131
Practice Address - Street 1:3040 E CACTUS RD
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7196
Practice Address - Country:US
Practice Address - Phone:602-494-1515
Practice Address - Fax:602-494-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1400103TA0400X, 103T00000X, 103TC1900X, 103TP2701X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily