Basic Information
| Provider Information | |||||||||
| NPI: | 1114526159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MXMAHON | ||||||||
| FirstName: | SHIRLEY (DUFFY) | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4555 E INVERNESS AVE BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808303900 | ||||||||
| FaxNumber: | 4808303901 | ||||||||
| Practice Location | |||||||||
| Address1: | 4555 E INVERNESS AVE BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808303900 | ||||||||
| FaxNumber: | 4808303901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0100X | Y | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No ID Information.