Provider Demographics
NPI:1366681348
Name:COLATTUR, NANCY LYNN (MSW, LCSW, LISAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:COLATTUR
Suffix:
Gender:F
Credentials:MSW, LCSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 W QUAIL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9570
Mailing Address - Country:US
Mailing Address - Phone:623-376-0367
Mailing Address - Fax:
Practice Address - Street 1:18001 N 79TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8388
Practice Address - Country:US
Practice Address - Phone:623-377-1128
Practice Address - Fax:623-572-3172
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11454101YA0400X
AZLCSW-112291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)