Provider Demographics
NPI:1518027499
Name:SPAYER, MARJEAN (PH D)
Entity Type:Individual
Prefix:DR
First Name:MARJEAN
Middle Name:
Last Name:SPAYER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARJEAN SPAYER, PH.D., P.C.
Mailing Address - Street 2:P. O. BOX 13242
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013
Mailing Address - Country:US
Mailing Address - Phone:505-521-4800
Mailing Address - Fax:505-521-6399
Practice Address - Street 1:3003 HILLRISE DR
Practice Address - Street 2:SUITE B-2
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4897
Practice Address - Country:US
Practice Address - Phone:505-521-4800
Practice Address - Fax:505-521-6399
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM577103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN5786Medicaid