Provider Demographics
NPI:1003152489
Name:WENDY HART PH.D., PC
Entity Type:Organization
Organization Name:WENDY HART PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-775-8811
Mailing Address - Street 1:2222 S DOBSON RD
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6481
Mailing Address - Country:US
Mailing Address - Phone:480-775-8811
Mailing Address - Fax:480-775-8866
Practice Address - Street 1:2222 S DOBSON RD
Practice Address - Street 2:SUITE 1004
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6481
Practice Address - Country:US
Practice Address - Phone:480-775-8811
Practice Address - Fax:480-775-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2039261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ44395Medicare UPIN
AZ103279Medicare PIN