Provider Demographics
NPI:1871941963
Name:PERRIZO, NATHANAEL (MSC)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:
Last Name:PERRIZO
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8847 E POSADA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2842
Mailing Address - Country:US
Mailing Address - Phone:480-290-2533
Mailing Address - Fax:
Practice Address - Street 1:2563 S VAL VISTA DR
Practice Address - Street 2:SE CORNER OF VAL VISTA AND WILLIAMS FIELD
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1804
Practice Address - Country:US
Practice Address - Phone:480-290-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16066101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor