Healthcare Provider Details

I. General information

NPI: 1164529483
Provider Name (Legal Business Name): AMY BETH WRABETZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N. HWY 89 MHC (116)
PRESCOTT AZ
86313
US

IV. Provider business mailing address

NAVAHCS 500 N. HWY 89 MHC (116)
PRESCOTT AZ
86313
US

V. Phone/Fax

Practice location:
  • Phone: 928-776-6071
  • Fax: 928-776-6125
Mailing address:
  • Phone: 928-776-6071
  • Fax: 928-776-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3263
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: