Provider Demographics
NPI:1245819648
Name:MAHAN, AMBER LEIGH (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:LEIGH
Last Name:MAHAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14300 N NORTHSIGHT BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3677
Mailing Address - Country:US
Mailing Address - Phone:623-414-3279
Mailing Address - Fax:855-850-8159
Practice Address - Street 1:14300 N NORTHSIGHT BLVD STE 215
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3677
Practice Address - Country:US
Practice Address - Phone:623-414-3279
Practice Address - Fax:855-850-8159
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5665103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist