Healthcare Provider Details

I. General information

NPI: 1548996671
Provider Name (Legal Business Name): SYBIL NWULU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E PALM LN STE 255
PHOENIX AZ
85004-4604
US

IV. Provider business mailing address

1151 S FOREST AVE
TEMPE AZ
85281-2001
US

V. Phone/Fax

Practice location:
  • Phone: 602-918-3664
  • Fax: 480-681-1916
Mailing address:
  • Phone: 602-598-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-22228
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: