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General NPI Number Information
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NPI Number | 1003932898
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Entity Type | Organization
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Legal Business Name | MOUNTAIN WAVES HEALING ARTS, INC.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 2323 E GREENLAW LN SUITE 10
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-1810
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Country | US
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Telephone | 928-526-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 E GREENLAW LN SUITE 10
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-1810
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Country | US
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Telephone | 928-526-5171
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ROXANNE R WITTE
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Credential | PH.D.
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Telephone | 928-526-1961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | AZ1575
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License Number State | AZ
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