Provider Demographics
NPI:1245028745
Name:RD PSYCHE PLLC
Entity type:Organization
Organization Name:RD PSYCHE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,MSN,ACNPAG,PMHNP
Authorized Official - Phone:623-261-5258
Mailing Address - Street 1:5519 W BANFF LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3045
Mailing Address - Country:US
Mailing Address - Phone:623-261-5258
Mailing Address - Fax:623-432-7006
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4712
Practice Address - Country:US
Practice Address - Phone:623-301-9992
Practice Address - Fax:623-432-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty