Provider Demographics
NPI:1720552193
Name:NOCKELS, PAUL ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
Last Name:NOCKELS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FOX LAIR DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7796
Mailing Address - Country:US
Mailing Address - Phone:928-814-1385
Mailing Address - Fax:
Practice Address - Street 1:3600 FOX LAIR DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7796
Practice Address - Country:US
Practice Address - Phone:928-814-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005040103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist