MEDICARE: PHILIP NICE LCSW, LISAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LISAC-1597	AZ
2	1041C0700X	Clinical Social Worker	LCSW-4108	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699833624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP NICE LCSW, LISAC

Provider Business Mailing Address
First Line	:	PO BOX 3160
Second Line	:
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85217-3160
Country	:	US
Telephone Number	:	480-983-0065
Fax Number	:	480-288-5339

Provider Business Practice Location Address
First Line	:	980 E. MT. LEMON ROAD
Second Line	:
City	:	ORACLE
State	:	AZ
Zip	:	85623
Country	:	US
Telephone Number	:	480-983-0065
Fax Number	:	480-288-5339

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/11/2025

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Directions to “ PHILIP NICE LCSW, LISAC” Practice Location

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