Active NPI
Mark J Harvancik, EDD
- Psychologist
- Kingman, AZ
National Provider Identifier
1619963683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2087
- Practice address
- 701 Stockton Hill Rd Ste N
Kingman, AZ 86401-7103 - Phone
- (928) 727-7776
- Fax
- (928) 753-6938
- NPI assigned
- Sep 23, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2087 | AZ | Primary |
Addresses
Primary practice location
701 Stockton Hill Rd Ste N
Kingman, AZ 86401-7103
Mailing address
701 Stockton Hill Rd Ste N
Kingman, AZ 86401-7103
Phone (928) 727-7776
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2087 | AZ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274400000000",
"number": "1619963683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 STOCKTON HILL RD STE N",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864017103",
"telephone_number": "928-727-7776",
"fax_number": "928-753-6938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 STOCKTON HILL RD STE N",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864017103",
"telephone_number": "928-727-7776",
"fax_number": "928-753-6938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARVANCIK",
"first_name": "MARK",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "EDD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-23",
"last_updated": "2010-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "2087",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingman, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.