| Wayne A. Formica | |
|
2055 W Fruit Tree Ln Queen Creek AZ 85242-6356 | |
| (480) 677-4804 | |
| (480) 677-4804 |
| Full Name | Wayne A. Formica |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2055 W Fruit Tree Ln, Queen Creek, Arizona |
| Authorized Official Name and Position | Wayne Arthur Formica (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 4806774804 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wayne A. Formica 2055 W Fruit Tree Ln Queen Creek AZ 85242-6356 Ph: (480) 677-4804 | Wayne A. Formica 2055 W Fruit Tree Ln Queen Creek AZ 85242-6356 Ph: (480) 677-4804 |
| NPI Number | 1902092422 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 09/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902092422 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC 10413 (Arizona) | Primary |
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