Provider Demographics
NPI:1629277124
Name:ANDREA WADDELL-PRATT, PHD, PC
Entity Type:Organization
Organization Name:ANDREA WADDELL-PRATT, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WADDELL-PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-462-1115
Mailing Address - Street 1:810 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1318
Mailing Address - Country:US
Mailing Address - Phone:692-462-1115
Mailing Address - Fax:602-462-1119
Practice Address - Street 1:810 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1318
Practice Address - Country:US
Practice Address - Phone:692-462-1115
Practice Address - Fax:602-462-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3384251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health