Provider Demographics
NPI:1710935515
Name:LETT, PHILLIP D (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:D
Last Name:LETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4222 E CAMELBACK RD
Mailing Address - Street 2:H230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2745
Mailing Address - Country:US
Mailing Address - Phone:602-852-0911
Mailing Address - Fax:602-852-0632
Practice Address - Street 1:4222 E CAMELBACK RD
Practice Address - Street 2:H230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2732
Practice Address - Country:US
Practice Address - Phone:602-852-0911
Practice Address - Fax:602-852-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1627103TR0400X, 103TA0400X, 103TC2200X, 103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist