Provider Demographics
NPI:1992036545
Name:MARCANN MENTAL HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:MARCANN MENTAL HEALTH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-574-4713
Mailing Address - Street 1:3815 E BELL RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2177
Mailing Address - Country:US
Mailing Address - Phone:602-824-9309
Mailing Address - Fax:
Practice Address - Street 1:3815 E BELL RD STE 1500
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2177
Practice Address - Country:US
Practice Address - Phone:602-824-9309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3981103TC0700X
IL071006204103TC0700X
IL209005463041233170363LP0808X
AZAP3318363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1548318892Medicare UPIN