Provider Demographics
NPI:1891296380
Name:DUST, NELLE KLEA (BACHELOR DEGREE)
Entity Type:Individual
Prefix:
First Name:NELLE
Middle Name:KLEA
Last Name:DUST
Suffix:
Gender:F
Credentials:BACHELOR DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15255 N FRANK LLOYD WRIGHT BLVD APT 1068
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2805
Mailing Address - Country:US
Mailing Address - Phone:618-541-4552
Mailing Address - Fax:
Practice Address - Street 1:15721 N GREENWAY HAYDEN LOOP STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1776
Practice Address - Country:US
Practice Address - Phone:602-362-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQBH558M92361OtherBLUE CROSS