MEDICARE: MS. LORRAINE MISCHKE LASAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LASAC-15313	AZ

General Provider Information

NPI Number	:	1659075554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORRAINE MISCHKE LASAC

Provider Business Mailing Address
First Line	:	4425 N 78TH ST APT 157B
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2548
Country	:	US
Telephone Number	:	480-567-2235
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 N 78TH ST APT 157B
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2548
Country	:	US
Telephone Number	:	480-567-2235
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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