Healthcare Provider Details

I. General information

NPI: 1164416970
Provider Name (Legal Business Name): SUSAN YAP LASSITER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SUSAN ELIZABETH YAP LPC

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N IRONWOOD DR 110
APACHE JUNCTION AZ
85220-3830
US

IV. Provider business mailing address

7452 E KIOWA AVE
MESA AZ
85209-6239
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-2356
  • Fax:
Mailing address:
  • Phone: 480-250-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-10907
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3684
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: