Individual
DR. MARTY P. WITUCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5221
(479) 787-5613
Mailing address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5221
(479) 787-5613
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
16-22P
AR
103TC0700X
Clinical Psychologist
263
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18115
—
ND
05
—
621823700
—
MN
Enumeration date
07/10/2006
Last updated
05/22/2025
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