Physician Compare National (NPI:1265442628)

HEALTHCARE PROVIDER: AMANDA CHRISTINE NELLIS PH.D., LPC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1265442628
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587088984
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200717002287
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NELLIS
	Individual professional last name
Provider First Name	AMANDA
	Individual professional first name
Provider Middle Name	CHRISTINE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	7301 N 16TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	PHOENIX
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	850205266
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6023016670016670
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y