Provider Demographics
NPI:1831551696
Name:MARDEN PETRIE, PSYD, PLLC
Entity type:Organization
Organization Name:MARDEN PETRIE, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:520-488-4602
Mailing Address - Street 1:11114 N FALLING RAIN RD
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7321
Mailing Address - Country:US
Mailing Address - Phone:520-488-4602
Mailing Address - Fax:888-429-6085
Practice Address - Street 1:6592 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5640
Practice Address - Country:US
Practice Address - Phone:520-488-4602
Practice Address - Fax:888-429-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty