Provider Demographics
NPI:1285330449
Name:NASH, KIRSTY H (MC)
Entity type:Individual
Prefix:
First Name:KIRSTY
Middle Name:H
Last Name:NASH
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 E BRIDGEPORT PKWY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2032
Mailing Address - Country:US
Mailing Address - Phone:480-330-2837
Mailing Address - Fax:
Practice Address - Street 1:3180 S GILBERT RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5105
Practice Address - Country:US
Practice Address - Phone:480-330-2837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health