Marty P. Witucki, PH.D.
Individual provider Active NPI Clinical Psychologist · Gravette, AR
NPI 1477587772 · NPPES record last updated May 22, 2025
Key facts
- NPI
- 1477587772
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 16-22P (AR)
- Practice address
- 1101 Jackson St SW
Gravette, AR 72736-9121 - Phone
- (479) 787-5221
- Fax
- (479) 787-5613
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Wind Psychological Services
Practice addresses (Care Compare)
3333 S Pinnacle Hills Pkwy
Suite 435
Rogers, AR 72758-9095
Phone (479) 235-4146
Hospital & facility affiliations
- Ozarks Community Hospital of Gravette
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180109003432 | AR | Practitioner - Clinical Psychologist | 5799718243 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16-22P | AR | MD | Clinical Psychologist |
| 263 | ND | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Wind Psychological Services | Current |
Accepting new patients | |
| Sgoh Acquisition Inc | Current |
Accepting new patients | |
| Chenal Family Therapy, PLC | Current |
Accepting new patients | |
| Sgoh Acquisition Inc | Current |
Accepting new patients | |
| Tara M. Cole, PH.D., P.a. | Clinical | Past | Accepting new patients |
| Transitions Counseling Clinic PLC | Clinical | Past |
Accepting new patients |
Locations
803 SE Plaza Ave
Ste 7
Bentonville, AR 72712
304 W Collin Raye Dr
Ste 103A
De Queen, AR 71832
Phone (870) 200-9294
1101 Jackson St SW
Gravette, AR 72736
Phone (479) 787-5221
10311 W Markham St
Little Rock, AR 72205
Phone (501) 681-3300
3333 S Pinnacle Hills Pkwy
Ste 435
Rogers, AR 72758
Phone (479) 235-4146
Interoperability endpoints
- mwitucki@ochhospital.hin.us
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 263 | ND | |
| Clinical Psychologist | 103TC0700X | 16-22P | AR | Yes |
Addresses
Primary practice location
1101 Jackson St SW
Gravette, AR 72736-9121
Mailing address
1101 Jackson St SW
Gravette, AR 72736-9121
Phone (479) 787-5221
Other practice location 1
3214 NW Avignon Way
Suite 2
Bentonville, AR 72712-3916
Phone (479) 271-8778
Other practice location 2
803 SE Plaza Ave Ste 7
Bentonville, AR 72712-7830
Phone (479) 595-0333
Other practice location 3
3333 S Pinnacle Hills Pkwy Ste 435
Rogers, AR 72758-9095
Phone (479) 235-4146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 621823700 | Medicaid | MN | |
| 18115 | Medicaid | ND |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | MWITUCKI@OCHHOSPITAL.HIN.US |
Other providers in Gravette, AR
All providers in Gravette, AR · Clinical Psychologist in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.