Nicole J Wolf, PHD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP5468 Issued in MN

Practice address

1515 E Cedar Ave Ste B-4
Flagstaff, AZ 86004-1645

Phone

(928) 779-4550

Fax

(928) 779-4493

NPI assigned

Jan 23, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southwest Behavioral Health Services Inc

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1144384389
  Medicare reassignment NPD
• Nicole J Wolf PHD LP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1801308077
  NPD Authorized official
• Southwest Behavioral Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Prescott Valley, AZ
  • NPI 1275907511
  NPD
• Southwest Behavioral Health Services, Inc.

  • Psychiatric Residential Treatment Facility
  • Kingman, AZ
  • NPI 1023556339
  NPD
• Southwest Behavioral Health Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Prescott Valley, AZ
  • NPI 1578844726
  NPD (past)
• Counseling Services of Southern Minnesota, Inc

  • Clinical Social Worker
  • Saint Peter, MN
  • NPI 1962557496

  Psychologist

  NPD (past)
• Washburn Center for Children

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1225136419
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1295006203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 N 3RD ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122331",
            "telephone_number": "602-351-6986",
            "fax_number": "602-266-9025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E CEDAR AVE STE B-4",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041645",
            "telephone_number": "928-779-4550",
            "fax_number": "928-779-4493"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "116 S 3rd St",
            "address_purpose": "LOCATION",
            "city": "Saint Peter",
            "state": "MN",
            "postal_code": "560822043",
            "country_code": "US",
            "telephone_number": "507-931-8040",
            "fax_number": "507-931-8060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLF",
        "first_name": "NICOLE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-23",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP5468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "LP5468",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Elaine Witt, R.N.
• James Michael Wittekind, P.T., D.P.T.
• Laura R Wittke, MS RD
• Michaela Wixom
• Bret Bartholomew Wojciak, NMD
• Sandra Lynn Wolfe, D.C.
• Summer Wolfe, DNP, APRN, PMHNP-BC
• Kalie Wolfinger
• Karen Anne Wolfson, PHARM.D.
• Clayton Womack, CPNP-AC

• Psychologist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.