Provider Demographics
NPI:1497312318
Name:RUNNELS, TAWNY NICOLE WHITE (MC, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:TAWNY
Middle Name:NICOLE WHITE
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:MC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 W HAPPY VALLEY RD STE A104-148
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2609
Mailing Address - Country:US
Mailing Address - Phone:623-680-3469
Mailing Address - Fax:
Practice Address - Street 1:6635 W HAPPY VALLEY RD STE A104-148
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2609
Practice Address - Country:US
Practice Address - Phone:623-680-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18204101YP2500X
AZLAC-16364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional