Healthcare Provider Details

I. General information

NPI: 1073317921
Provider Name (Legal Business Name): JASON INMAN MA, LAC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 168
GLENDALE AZ
85308-4624
US

IV. Provider business mailing address

3700 N CATHERINE DR
PRESCOTT VALLEY AZ
86314-8338
US

V. Phone/Fax

Practice location:
  • Phone: 844-385-3747
  • Fax:
Mailing address:
  • Phone: 928-460-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-22992
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: