Provider Demographics
NPI:1689799959
Name:MULTISPORT PSYCHOLOGICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:MULTISPORT PSYCHOLOGICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:602-561-0920
Mailing Address - Street 1:17235 N 75TH AVE
Mailing Address - Street 2:SUITE E-170
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0831
Mailing Address - Country:US
Mailing Address - Phone:602-561-0920
Mailing Address - Fax:623-486-1636
Practice Address - Street 1:17235 N 75TH AVE
Practice Address - Street 2:SUITE E-170
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0831
Practice Address - Country:US
Practice Address - Phone:602-561-0920
Practice Address - Fax:623-486-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3865103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty