Provider Demographics
NPI:1699833624
Name:NICE, PHILIP (LCSW, LISAC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:NICE
Suffix:
Gender:M
Credentials: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:PO BOX 3160
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85217-3160
Mailing Address - Country:US
Mailing Address - Phone:480-983-0065
Mailing Address - Fax:480-288-5339
Practice Address - Street 1:980 E. MT. LEMON ROAD
Practice Address - Street 2:
Practice Address - City:ORACLE
Practice Address - State:AZ
Practice Address - Zip Code:85623
Practice Address - Country:US
Practice Address - Phone:480-983-0065
Practice Address - Fax:480-288-5339
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-1597101YA0400X
AZLCSW-41081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ752528Medicaid