Provider Demographics
NPI:1265025407
Name:PRILL IRVINE, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:PRILL IRVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16117 W GLENROSA AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7770
Mailing Address - Country:US
Mailing Address - Phone:623-760-2020
Mailing Address - Fax:
Practice Address - Street 1:250 N LITCHFIELD RD STE 201
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1372
Practice Address - Country:US
Practice Address - Phone:623-337-2275
Practice Address - Fax:623-800-7626
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional