Healthcare Provider Details

I. General information

NPI: 1821922774
Provider Name (Legal Business Name): MICHEAL NICOLE FROST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17235 N 75TH AVE STE F100
GLENDALE AZ
85308-0871
US

IV. Provider business mailing address

1645 W KURALT DR
ANTHEM AZ
85086-3688
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-1165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: