Provider Demographics
NPI:1962678797
Name:TIMOTHY MACK TAYS PHD PC
Entity Type:Organization
Organization Name:TIMOTHY MACK TAYS PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:TAYS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-281-1478
Mailing Address - Street 1:15849 N 71ST ST #100
Mailing Address - Street 2:KIERLAND BUSINESS CENTER
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:480-281-1478
Mailing Address - Fax:480-281-1500
Practice Address - Street 1:15849 N 71ST ST #100
Practice Address - Street 2:KIERLAND BUSINESS CENTER
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:480-281-1478
Practice Address - Fax:480-281-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107719Medicare PIN