Provider Demographics
NPI:1295006203
Name:WOLF, NICOLE J (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:J
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2331
Mailing Address - Country:US
Mailing Address - Phone:602-351-6986
Mailing Address - Fax:602-266-9025
Practice Address - Street 1:1515 E CEDAR AVE STE B-4
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1645
Practice Address - Country:US
Practice Address - Phone:928-779-4550
Practice Address - Fax:928-779-4493
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP5468OtherLICENSE