Provider Demographics
NPI:1720247240
Name:DR MARY PALMQUIST PLLC
Entity Type:Organization
Organization Name:DR MARY PALMQUIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-310-2810
Mailing Address - Street 1:6040 E MAIN ST
Mailing Address - Street 2:405
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8928
Mailing Address - Country:US
Mailing Address - Phone:480-310-2810
Mailing Address - Fax:480-284-5425
Practice Address - Street 1:1237 S VAL VISTA DR
Practice Address - Street 2:VAL VISTA EXECUTIVE SUITES
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6401
Practice Address - Country:US
Practice Address - Phone:480-844-5125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3952251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health