Provider Demographics
NPI:1528182763
Name:MESSICK, MARIA ELIDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELIDA
Last Name:MESSICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELIDA
Other - Middle Name:MARIA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6611 W LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-1046
Mailing Address - Country:US
Mailing Address - Phone:623-691-5618
Mailing Address - Fax:623-691-5620
Practice Address - Street 1:7125 W ENCANTO BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-1335
Practice Address - Country:US
Practice Address - Phone:623-691-5618
Practice Address - Fax:623-691-5620
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3090235103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool