Provider Demographics
NPI:1962617936
Name:MONGELLUZZO, NANETTE DARLENE (LPC)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:DARLENE
Last Name:MONGELLUZZO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CATHEDRAL ROCK DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8640
Mailing Address - Country:US
Mailing Address - Phone:928-284-0774
Mailing Address - Fax:
Practice Address - Street 1:155 CATHEDRAL ROCK DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8640
Practice Address - Country:US
Practice Address - Phone:928-284-0774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional