Healthcare Provider Details

I. General information

NPI: 1790141422
Provider Name (Legal Business Name): NICOLE LAWSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37200 N GANTZEL RD STE 200
SAN TAN VALLEY AZ
85140-7385
US

IV. Provider business mailing address

37200 N GANTZEL RD STE 200
SAN TAN VALLEY AZ
85140-7385
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-5066
  • Fax:
Mailing address:
  • Phone: 888-374-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1300
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number16003
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: