Provider Demographics
NPI:1013936228
Name:OGUS, ALAN LEE (PH D)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LEE
Last Name:OGUS
Suffix:
Gender:M
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 1:3430 NORTH MOUNTAIN RIDGE
Mailing Address - Street 2:UNIT 70
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207
Mailing Address - Country:US
Mailing Address - Phone:480-830-3963
Mailing Address - Fax:602-230-2026
Practice Address - Street 1:110 WEST CAMELBACK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-230-2222
Practice Address - Fax:602-230-2026
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3463103TB0200X
NC1008103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ787624OtherAHCCS PROVIDER NUMBER