Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 1627 | AZ |
N | 103TC0700X | Clinical Psychologist | 1627 | AZ |
N | 102L00000X | Psychologist | 1627 | AZ |
N | 103T00000X | Psychologist | 1627 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1627 | AZ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1627 | AZ |
Y | 103TR0400X | Rehabilitation Psychologist | 1627 | AZ |
NPI | 1710935515 |
---|---|
Provider Name | Dr. Phillip D Lett |
First Address | Phoenix, AZ 85018-2745 |
Second Address | Phoenix, AZ 85018-2732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 12/04/2013 |