MEDICARE: CARISSA NOEL 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1770357246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA NOEL LASAC

Provider Business Mailing Address
First Line	:	2950 S ALMA SCHOOL RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-4035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2950 S ALMA SCHOOL RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-4035
Country	:	US
Telephone Number	:	480-821-1330
Fax Number	:

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

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/14/2023

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Directions to “ CARISSA NOEL LASAC” Practice Location

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