Marty P. Witucki, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

16-22P Issued in AR

Practice address

1101 Jackson St SW
Gravette, AR 72736-9121

Phone

(479) 787-5221

Fax

(479) 787-5613

NPI assigned

Jul 10, 2006

Last updated

May 22, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Clinical Psychologist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Wind Psychological ServicesGroup PAC ID 4486094398, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ozarks Community Hospital of Gravette Hospital, Gravette, AR, CCN 041331

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwitucki@ochhospital.hin.us

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

• South Wind Psychological Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rogers, AR
  • NPI 1205369824
  Medicare reassignment Care Compare group NPD
• Chenal Family Therapy, PLC

  • Mental Health Counselor
  • Little Rock, AR
  • NPI 1356604219
  Medicare reassignment NPD
• Sgoh Acquisition Inc

  dba Ozarks Community Hospital of Gravette

  • Critical Access Hospital
  • Gravette, AR
  • NPI 1568643005
  Medicare reassignment NPD
• Sgoh Acquisition Inc

  dba Och Decatur Clinic

  • Rural Health Clinic/Center
  • Decatur, AR
  • NPI 1699513507
  NPD
• Tara M. Cole, PH.D., P.a.

  • Clinical Psychologist
  • Bentonville, AR
  • NPI 1619307204
  NPD (past)
• Transitions Counseling Clinic PLC

  • Professional Counselor
  • De Queen, AR
  • NPI 1902501281

  Clinical

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sgoh Acquisition Inc

  dba Ozarks Community Hospital of Gravette

  • Critical Access Hospital
  • Gravette, AR
  • NPI 1568643005
  Care Compare affiliation

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1477587772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 JACKSON ST SW",
            "city": "GRAVETTE",
            "state": "AR",
            "postal_code": "727369121",
            "telephone_number": "479-787-5221",
            "fax_number": "479-787-5613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 JACKSON ST SW",
            "city": "GRAVETTE",
            "state": "AR",
            "postal_code": "727369121",
            "telephone_number": "479-787-5221",
            "fax_number": "479-787-5613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3214 NW Avignon Way",
            "address_2": "Suite 2",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727123916",
            "country_code": "US",
            "telephone_number": "479-271-8778",
            "fax_number": "888-207-6093",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "803 SE Plaza Ave Ste 7",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727127830",
            "country_code": "US",
            "telephone_number": "479-595-0333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 S Pinnacle Hills Pkwy Ste 435",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727589095",
            "country_code": "US",
            "telephone_number": "479-235-4146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WITUCKI",
        "first_name": "MARTY",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ND",
            "license": "263",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AR",
            "license": "16-22P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MWITUCKI@OCHHOSPITAL.HIN.US",
            "affiliation": "N",
            "address_1": "1101 Jackson St SW",
            "city": "Gravette",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727369121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wal-Mart Stores Inc (Wal-Mart Pharmacy 10-3033)
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• Lindsey S Watford, PHARMD
• William Frank Webb, MD
• Steven L. Williams, D.O.

• Clinical Psychologist in Gravette, AR
• Providers in Gravette, AR by specialty
• Clinical Psychologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.