Provider Demographics
NPI:1679532998
Name:THORSTAD, ROXANE RENEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROXANE
Middle Name:RENEE
Last Name:THORSTAD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 S RURAL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3880
Mailing Address - Country:US
Mailing Address - Phone:480-656-0500
Mailing Address - Fax:480-656-0770
Practice Address - Street 1:6515 S RURAL RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3880
Practice Address - Country:US
Practice Address - Phone:480-656-0500
Practice Address - Fax:480-656-0770
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical