Individual
NICOLE LYNN OUTLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
17505 N 79TH AVE STE 311G, GLENDALE, AZ 85308-8730
(623) 876-2029
Mailing address
6117 N 12TH ST UNIT 7, PHOENIX, AZ 85014-1718
(928) 900-3008
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-21448
AZ
Other
Enumeration date
12/06/2022
Last updated
12/06/2022
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