Provider Demographics
NPI:1609104306
Name:TORRES, NELSON (LISAC)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5062 N 19TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3225
Mailing Address - Country:US
Mailing Address - Phone:623-939-6567
Mailing Address - Fax:623-939-7365
Practice Address - Street 1:5062 N 19TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3225
Practice Address - Country:US
Practice Address - Phone:623-939-6567
Practice Address - Fax:623-939-7365
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0535101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor