Provider Demographics
NPI:1710450879
Name:GERLACH, NANCY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:GERLACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35810 N 33RD LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4201
Mailing Address - Country:US
Mailing Address - Phone:602-525-4767
Mailing Address - Fax:
Practice Address - Street 1:155 PARTRIDGE LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-5330
Practice Address - Country:US
Practice Address - Phone:602-525-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-17499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional