Provider Demographics
NPI:1538454970
Name:NORTHWEST COUNSELING AND ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTHWEST COUNSELING AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:C
Authorized Official - Last Name:NELLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-236-9295
Mailing Address - Street 1:18301 N 79TH AVE
Mailing Address - Street 2:STE. F170
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8463
Mailing Address - Country:US
Mailing Address - Phone:623-236-9295
Mailing Address - Fax:623-236-8819
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:STE. F170
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8463
Practice Address - Country:US
Practice Address - Phone:623-236-9295
Practice Address - Fax:623-236-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty