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General NPI Number Information
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NPI Number | 1063828663
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Entity Type | Individual
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Provider Name | BRENDA LEE NEELEY LMSW, LISAC
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Gender | Female
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Dates
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Enumeration Date | 07/03/2014
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Last Update Date | 07/03/2014
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Provider Practice Location Address
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Address Line | 13100 S. SUNLAND GIN ROAD
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City | ARIZONA CITY
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State | AZ
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Zip | 85123-4872
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Country | US
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Telephone | 520-413-2750
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Fax | 520-466-5266
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Provider Business Mailing Address
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Address Line | PO BOX 4872
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City | ARIZONA CITY
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State | AZ
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Zip | 85123-2730
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Country | US
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Telephone | 520-413-2750
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Fax | 520-466-5266
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC-11428
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-13976
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License Number State | AZ
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