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General NPI Number Information
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NPI Number | 1164992236
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Entity Type | Individual
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Provider Name | MR. JAMES CLARENCE NELLIS
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Gender | Male
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 5010 EAST SHEA BLVD. SUITE D202 ACT COUNSELING & EDUCAT
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4570
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Country | US
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Telephone | 602-509-4328
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Fax | 602-507-4328
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Provider Business Mailing Address
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Address Line | ACT COUNSELING & EDUCATION 5010 EAST SHEA BLVD. SUITE D 202
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4570
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Country | US
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Telephone | 602-509-4328
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Fax | 602-507-4327
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | AZ
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