MEDICARE: JIMMY NEALY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	BH5419	AZ

General Provider Information

NPI Number	:	1154807113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY NEALY

Provider Business Mailing Address
First Line	:	3310 N EL BURRITO AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-3404
Country	:	US
Telephone Number	:	520-300-4976
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 N EL BURRITO AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-3404
Country	:	US
Telephone Number	:	520-300-4976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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Directions to “ JIMMY NEALY ” Practice Location

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