Provider Demographics
NPI:1003850892
Name:DYER, DEBORAH (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:BUROWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 168007
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-8007
Mailing Address - Country:US
Mailing Address - Phone:469-735-4555
Mailing Address - Fax:469-735-4640
Practice Address - Street 1:1150 S. FOREST AVE SSV 334
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85287
Practice Address - Country:US
Practice Address - Phone:480-965-6147
Practice Address - Fax:480-965-3426
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3513103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134426Medicaid