Provider Demographics
NPI:1497801781
Name:WYMAN, HEIDI ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:ELAINE
Last Name:WYMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 E MILKY WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-9131
Mailing Address - Country:US
Mailing Address - Phone:480-279-6292
Mailing Address - Fax:
Practice Address - Street 1:1232 E BROADWAY RD
Practice Address - Street 2:STE 120
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1511
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:480-963-3294
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMFT10036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist