Healthcare Provider Details

I. General information

NPI: 1972075299
Provider Name (Legal Business Name): NICOLE MCCALLISTER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 E DESERT COVE AVE
SCOTTSDALE AZ
85260-6746
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 480-314-6670
  • Fax: 480-257-1997
Mailing address:
  • Phone: 480-245-6286
  • Fax: 480-398-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17821
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: