Provider Demographics
NPI:1831825348
Name:MANSOOR, JOHN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MANSOOR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W RIO SALADO PKWY APT 3012
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6285
Mailing Address - Country:US
Mailing Address - Phone:480-522-8636
Mailing Address - Fax:
Practice Address - Street 1:337 E CORONADO RD STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1583
Practice Address - Country:US
Practice Address - Phone:480-712-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical