Healthcare Provider Details

I. General information

NPI: 1982945739
Provider Name (Legal Business Name): MS. HOLLY NOEL ESSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 W BETHANY HOME RD
PHOENIX AZ
85015-1935
US

IV. Provider business mailing address

2102 W BETHANY HOME RD
PHOENIX AZ
85015-1935
US

V. Phone/Fax

Practice location:
  • Phone: 701-260-8874
  • Fax:
Mailing address:
  • Phone: 701-260-8874
  • Fax: 623-205-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-17447
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4725
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: