Provider Demographics
NPI:1992837231
Name:WALLETT, DEBRA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LEE
Last Name:WALLETT
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 1:9595 N PAQUETTE CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-6864
Mailing Address - Country:US
Mailing Address - Phone:207-450-3357
Mailing Address - Fax:
Practice Address - Street 1:9595 N PAQUETTE CIR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-6864
Practice Address - Country:US
Practice Address - Phone:207-450-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist