Healthcare Provider Details

I. General information

NPI: 1659679686
Provider Name (Legal Business Name): JORDANNA LAVINA SAUNDERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDANNA LAVINA BURKETT CRIST MC LCPC

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 N LITCHFIELD RD STE 7
GOODYEAR AZ
85395
US

IV. Provider business mailing address

2990 N LITCHFIELD RD STE 7
GOODYEAR AZ
85395-7800
US

V. Phone/Fax

Practice location:
  • Phone: 602-626-0540
  • Fax:
Mailing address:
  • Phone: 480-374-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-14035
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC 2226
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: