WAYNE A. FORMICA (NPI# 1902092422) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902092422 |
| Entity Type | Organization |
| Organization Name | WAYNE A. FORMICA |
| Practice Address |
2055 W Fruit Tree Ln Queen Creek AZ 85242-6356 |
| Practice Telephone | 4806774804 |
| Practice Fax Number | 4806774804 |
| Mailing Telephone | 4806774804 |
| Mailing Fax Number | 4806774804 |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2007-09-18 |
| Authorized Official Name | MR. WAYNE ARTHUR FORMICA (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Telephone | 4806774804 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | LPC 10413 | AZ | Agencies |
| Street Address |
2055 W FRUIT TREE LN |
| City | QUEEN CREEK |
| State | AZ |
| Zip Code | 85242-6356 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932430618 | Di Nguyen | Pharmacist | 3111 West Hunt Highway, Queen Creek, AZ 85242 | 2010-01-20 |
| 1174857056 | Jessica Lynn Donnelly | Behavioral Analyst | 21007 E. Avendia Del Valle, Queen Creek, AZ 85242 | 2009-09-25 |
| 1306093984 | Charles Mckenzie | Dentist | 40815 N Ironwood Drive, Ste A102, Queen Creek, AZ 85242 | 2008-08-26 |
| 1104014943 | Queen Creek Smiles, LLP | Dentist | 18550 East Rittenhouse Road, Suite 103, Queen Creek, AZ 85242 | 2007-10-05 |
| 1972700359 | Sunrise Internal Medicine PC | Internal Medicine | 22707 S. Ellsworth Rd., Suite #h105, Queen Creek, AZ 85242 | 2007-06-29 |
| 1083811277 | Brian Joseph Goodman | Dentist | 18610 E. Rittenhouse Rd., Queen Creek, AZ 85242 | 2007-06-29 |
| 1972704757 | San Tan Urgent Care Health Center | Clinic/Center | 21321 E Ocotillo Road, Suite 118, Queen Creek, AZ 85242 | 2007-05-30 |
| 1538375647 | Jennifer Jean Job | Occupational Therapy Assistant | 3575 E Lawndale Place, Queen Creek, AZ 85242 | 2007-05-15 |
| 1972718823 | Eric Joseph Harris | Dentist | 20261 E. Ocotillo Road, Suite 120, Queen Creek, AZ 85242 | 2007-05-14 |
| 1477767010 | San Tam Dental Care & Mobile Clinic PC | Dentist | 22240 S Ellsworth Rd, Suite 102, Queen Creek, AZ 85242 | 2007-05-10 |
| Find all providers in zip 85242 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811509573 | Cornerstone Health and Therapy LLC | Community/Behavioral Health | 20415 E Domingo Rd, Queen Creek, AZ 85142-2041 | 2020-08-23 |
| 1699330258 | Mbc LLC | Community/Behavioral Health | 2644 W Half Moon Cir, Queen Creek, AZ 85142-6640 | 2019-05-08 |
| 1639642036 | Brittany Ann Brown | Community/Behavioral Health | 1739 W Prospector Way, Queen Creek, AZ 85142-4450 | 2019-01-08 |
| 1710459607 | Touch Angels Behavioral Health Care LLC | Community/Behavioral Health | 21929 E Avenida Del Valle Ct, Queen Creek, AZ 85142-6343 | 2018-12-18 |
| 1710408877 | Ohana Caregivers LLC | Community/Behavioral Health | 3091 W Santa Cruz Ave, Queen Creek, AZ 85142-3022 | 2017-06-29 |
| 1619420502 | Equine Spirit Programs | Community/Behavioral Health | 17016 E San Tan Blvd, Queen Creek, AZ 85142-8049 | 2016-07-27 |
| 1669836649 | Horizon Health and Wellness, Inc. | Community/Behavioral Health | 22713 S. Ellsworth Road, Building A, Queen Creek, AZ 85142 | 2016-04-06 |
| 1427307768 | Rite of Passage, Inc. | Community/Behavioral Health | 20061 E Rittenhouse Road, Suite A, Queen Creek, AZ 85142 | 2012-08-31 |
| 1952665796 | Look Who's Talking, Pllc | Community/Behavioral Health | 22665 S 194th Way, Queen Creek, AZ 85142-8970 | 2012-06-26 |
| 1578707436 | Feathers of Flight L.L.C. | Community/Behavioral Health | 30872 N Royal Oak Way, Queen Creek, AZ 85243-4173 | 2009-04-22 |
| Find all providers in QUEEN CREEK | ||||
| City | QUEEN CREEK |
| Zip Code | 85242 |
Please comment or provide details below to improve the information on WAYNE A. FORMICA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.