Provider Demographics
NPI:1013930437
Name:PYBURN PH.D PLLC, CONNIE S (PH D)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:S
Last Name:PYBURN PH.D PLLC
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 S RURAL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3717
Mailing Address - Country:US
Mailing Address - Phone:480-577-5044
Mailing Address - Fax:480-345-2294
Practice Address - Street 1:6625 S RURAL RD
Practice Address - Street 2:STE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3717
Practice Address - Country:US
Practice Address - Phone:480-577-5044
Practice Address - Fax:480-345-2294
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist