Provider Demographics
NPI:1912506536
Name:NASRALLA, DAVID (LPC MA NCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NASRALLA
Suffix:
Gender:M
Credentials:LPC MA NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2623
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-2623
Mailing Address - Country:US
Mailing Address - Phone:970-317-5230
Mailing Address - Fax:
Practice Address - Street 1:422 PAGOSA ST STE 9
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-9955
Practice Address - Country:US
Practice Address - Phone:970-317-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016591101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional