Individual
DR. AMANDA CHRISTINE NELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LPC
Contact information
Practice address
7301 N 16TH ST STE 102, PHOENIX, AZ 85020-5266
(602) 734-0213
Mailing address
17080 W SAGUARO LN, SURPRISE, AZ 85388-1398
(602) 301-6670
(623) 537-1601
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC-2216
AZ
103TC1900X
Counseling Psychologist
Primary
4016
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
579401
—
AZ
Enumeration date
08/09/2006
Last updated
07/13/2022
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