Healthcare Provider Details

I. General information

NPI: 1669646592
Provider Name (Legal Business Name): NAZCARE - NEW DIRECTIONS WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 N. BANK STREET
KINGMAN AZ
86401
US

IV. Provider business mailing address

599 WHITE SPAR RD
PRESCOTT AZ
86303-4627
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-1213
  • Fax: 928-753-1217
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number786379
License Number StateAZ

VIII. Authorized Official

Name: GREG BILLI
Title or Position: CEO
Credential:
Phone: 928-442-9205