Wayne a. Formica

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC 10413 Issued in AZ

Legal business name

WAYNE A. FORMICA

Practice address

2055 W Fruit Tree LN
Queen Creek, AZ 85242-6356

Phone

(480) 677-4804

Fax

(480) 677-4804

NPI assigned

Sep 18, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Wayne Arthur Formica, LPC

Title

Licensed Professional Counselor

Phone

(480) 677-4804

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1902092422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 W FRUIT TREE LN",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "852426356",
            "telephone_number": "480-677-4804",
            "fax_number": "480-677-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 W FRUIT TREE LN",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "852426356",
            "telephone_number": "480-677-4804",
            "fax_number": "480-677-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE A. FORMICA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "FORMICA",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "LICENSED PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "480-677-4804",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "LPC 10413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walter M Dise
• Brandon Wan, DO
• Tiffany Wangard, LACTATION CONSULTANT
• James Burt Ward, D.C.
• Terry Watson, AGACNP-BC
• Breeane Wazney, MD
• Jessica Webb
• Lisa Lashelle Webster
• Keith Weisgerber, CSFA
• Kariessa Taylor Welch, FNP-C

• Community/Behavioral Health Agency in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Community/Behavioral Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.