Provider Information for 1497312318
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TAWNY NICOLE WHITE RUNNELS MC, LPC, NCC
Sex: Female
NPI: 1497312318
Last Updated: 2020-03-03
Certification Date: 2020-03-03
Certification Date: 2020-03-03
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1497312318 | ||||||||||||
| Enumeration Date | 2019-05-27 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 6635 W HAPPY VALLEY RD STE A104-148 GLENDALE, AZ 85310-2609 United States Phone: 623-680-3469 | Fax: | ||||||||||||
| Primary Practice Address | 6635 W HAPPY VALLEY RD STE A104-148 GLENDALE, AZ 85310-2609 United States Phone: 623-680-3469 | Fax: | ||||||||||||
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