Healthcare Provider Details

I. General information

NPI: 1306623509
Provider Name (Legal Business Name): JORDAN LAHAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 E PECOS RD
CHANDLER AZ
85225-6077
US

IV. Provider business mailing address

2141 E PECOS RD
CHANDLER AZ
85225-6077
US

V. Phone/Fax

Practice location:
  • Phone: 480-846-0607
  • Fax: 480-841-6696
Mailing address:
  • Phone: 480-846-0607
  • Fax: 480-841-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: