Provider Demographics
NPI:1265701817
Name:O'DONNELL, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:JARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4436 E RIVER OAK TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6959
Mailing Address - Country:US
Mailing Address - Phone:520-907-2860
Mailing Address - Fax:
Practice Address - Street 1:4739 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1256
Practice Address - Country:US
Practice Address - Phone:520-907-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional