Provider Demographics
NPI:1982294997
Name:MCCUDDY, WILLIAM TRAVIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TRAVIS
Last Name:MCCUDDY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 W THOMAS RD STE 315
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4422
Mailing Address - Country:US
Mailing Address - Phone:602-406-3671
Mailing Address - Fax:602-406-6115
Practice Address - Street 1:222 W THOMAS RD STE 315
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4422
Practice Address - Country:US
Practice Address - Phone:602-406-3671
Practice Address - Fax:602-406-6115
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty