Healthcare Provider Details

I. General information

NPI: 1114859220
Provider Name (Legal Business Name): SETH WU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N CARLISLE AVE
SOMERTON AZ
85350
US

IV. Provider business mailing address

PO BOX 3200
SOMERTON AZ
85350-3200
US

V. Phone/Fax

Practice location:
  • Phone: 928-341-6012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4767343
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: