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General NPI Number Information
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NPI Number | 1912929258
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Entity Type | Individual
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Provider Name | DARREN MICHAEL NEALIS LICSW
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 18313 PAULSON ST SW STE A
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City | ROCHESTER
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State | WA
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Zip | 98579-9262
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Country | US
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Telephone | 360-827-8400
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Fax | 360-273-7301
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Provider Business Mailing Address
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Address Line | PO BOX 3360
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City | PORTLAND
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State | OR
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Zip | 97208-3360
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60065730
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License Number State | WA
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