Provider Demographics
NPI:1518952662
Name:SIMPSON, MARK STEWART (PSYD, LADAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEWART
Last Name:SIMPSON
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Gender:M
Credentials:PSYD, LADAC
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Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:FORT DEFIANCE INDIAN HOSPITAL BOARD, INC
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:928-729-8506
Mailing Address - Fax:928-729-8502
Practice Address - Street 1:CORNER OF ROUTE N12 AND N7
Practice Address - Street 2:FORT DEFIANCE INDIAN HOSPITAL BOARD, INC
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-0649
Practice Address - Country:US
Practice Address - Phone:928-729-8506
Practice Address - Fax:928-729-8502
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2014-01-31
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Provider Licenses
StateLicense IDTaxonomies
NM0081081101YA0400X
NM0930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)