Provider Demographics
NPI:1790730117
Name:RETTS, WILLIAM L (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:RETTS
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 1:11024 N 28TH DR #290
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4373
Mailing Address - Country:US
Mailing Address - Phone:602-870-7710
Mailing Address - Fax:602-734-0692
Practice Address - Street 1:11024 N 28TH DR #290
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4373
Practice Address - Country:US
Practice Address - Phone:602-870-7710
Practice Address - Fax:602-734-0692
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ354103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0130920OtherBLUE CROSS BLUE SHIELD