MEDICARE: PATTY JILL SOTH LAC-T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LAC-08397T	AZ

General Provider Information

NPI Number	:	1538011473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTY JILL SOTH LAC-T

Provider Business Mailing Address
First Line	:	1302 N VIA RONDA ORIENTE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-4835
Country	:	US
Telephone Number	:	480-529-1832
Fax Number	:

Provider Business Practice Location Address
First Line	:	3580 W INA RD STE 220
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2276
Country	:	US
Telephone Number	:	480-529-1832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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