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General NPI Number Information
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NPI Number | 1114228160
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Entity Type | Organization
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Legal Business Name | NORTHWEST COUNSELING & ASSOCIATES
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 18301 N 79TH AVE STE F170
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City | GLENDALE
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State | AZ
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Zip | 85308-8463
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Country | US
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Telephone | 623-236-9295
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Fax | 623-236-8819
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Provider Business Mailing Address
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Address Line | 18301 N 79TH AVE STE F170
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City | GLENDALE
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State | AZ
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Zip | 85308-8463
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Country | US
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Telephone | 623-236-9295
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Fax | 623-236-8819
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Authorized Official
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Title or Position | PSYCHIATRIST/ OWNER
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Name | MR. RODOLFO C NELLAS
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Credential | M.D.
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Telephone | 602-361-1273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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