Healthcare Provider Details

I. General information

NPI: 1508765033
Provider Name (Legal Business Name): NICHOLAS MATTHEW SAUNDERS MC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 S CENTER ST
MESA AZ
85210-1306
US

IV. Provider business mailing address

1835 E OASIS DR
TEMPE AZ
85283-4286
US

V. Phone/Fax

Practice location:
  • Phone: 480-709-4635
  • Fax:
Mailing address:
  • Phone: 602-796-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24397
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: