Provider Demographics
NPI:1477066561
Name:MOUNTAINVIEW CLINICAL PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:MOUNTAINVIEW CLINICAL PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HUSK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CBIS
Authorized Official - Phone:480-280-6618
Mailing Address - Street 1:3217 E SHEA BLVD STE 168
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3381
Mailing Address - Country:US
Mailing Address - Phone:480-280-6618
Mailing Address - Fax:
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:480-280-6618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3959103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ489117Medicaid