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NPI Code Detail

MEDICARE: DR. AMANDA CHRISTINE NELLIS PH.D., LPC

MEDICARE: DR. AMANDA CHRISTINE NELLIS PH.D., LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist4016AZ
2101YM0800XMental Health CounselorLPC-2216AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265442628
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA CHRISTINE NELLIS PH.D., LPC
Provider Business Mailing Address
First Line : 17080 W SAGUARO LN
Second Line :
City : SURPRISE
State : AZ
Zip : 85388-1398
Country : US
Telephone Number : 602-301-6670
Fax Number : 623-537-1601
Provider Business Practice Location Address
First Line : 7301 N 16TH ST STE 102
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-5266
Country : US
Telephone Number : 602-734-0213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 07/13/2022

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