Healthcare Provider Details

I. General information

NPI: 1083853147
Provider Name (Legal Business Name): WOOTEN & ASSOCIATES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N 6TH AVE
PHOENIX AZ
85003-1318
US

IV. Provider business mailing address

810 N 6TH AVE
PHOENIX AZ
85003-1318
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1116
  • Fax: 602-462-1119
Mailing address:
  • Phone: 602-462-1116
  • Fax: 602-462-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3308
License Number StateAZ

VIII. Authorized Official

Name: DR. BUFFY T WOOTEN
Title or Position: MANAGING MEMBER
Credential: PH.D.
Phone: 602-462-1116