Provider Demographics
NPI:1174846273
Name:WOOTEN, HERBERT RAY (PHD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:RAY
Last Name:WOOTEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 E ELMVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3805
Mailing Address - Country:US
Mailing Address - Phone:210-508-5525
Mailing Address - Fax:
Practice Address - Street 1:187 E ELMVIEW PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3805
Practice Address - Country:US
Practice Address - Phone:210-508-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health