Provider Demographics
NPI:1538240742
Name:WOLF, AMOS NEAL (PHD)
Entity type:Individual
Prefix:DR
First Name:AMOS
Middle Name:NEAL
Last Name:WOLF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-6226
Mailing Address - Country:US
Mailing Address - Phone:512-365-2211
Mailing Address - Fax:512-352-6691
Practice Address - Street 1:300 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-3641
Practice Address - Country:US
Practice Address - Phone:512-365-2211
Practice Address - Fax:512-352-6691
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
246392OtherVALUE OPTIONS
6135007OtherUNITED HEALTHCARE
TX86675AOtherBLUE CROSS BLUE SHIELD
TX040498002Medicaid
10015889OtherAMERIGROUP
TX86675AOtherBLUE CROSS BLUE SHIELD
6135007OtherUNITED HEALTHCARE