Mosaic - Mumby Psychological Services

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

MOSAIC - MUMBY PSYCHOLOGICAL SERVICES

Practice address

11773 S 53Rd Dr
Laveen, AZ 85339-5432

Phone

(602) 902-6696

NPI assigned

Feb 19, 2021

Last updated

Feb 19, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susanne Mumby, PSYD, MSW

Title

Owner / Psychologist

Phone

(602) 902-6696

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1649863648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11773 S 53RD DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853395432",
            "telephone_number": "602-902-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11773 S 53RD DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853395432",
            "telephone_number": "602-902-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC - MUMBY PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-19",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "MUMBY",
        "authorized_official_first_name": "SUSANNE",
        "authorized_official_title_or_position": "OWNER / PSYCHOLOGIST",
        "authorized_official_telephone_number": "602-902-6696",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, MSW"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Laveen, AZ
• Providers in Laveen, AZ by specialty
• Clinical Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.