Healthcare Provider Details

I. General information

NPI: 1982530440
Provider Name (Legal Business Name): DANNY BERMUDEZ LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 S ALMA SCHOOL RD STE 230
MESA AZ
85210-3013
US

IV. Provider business mailing address

220 S LONGMORE ST
CHANDLER AZ
85224-6426
US

V. Phone/Fax

Practice location:
  • Phone: 480-818-9095
  • Fax:
Mailing address:
  • Phone: 928-446-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24137
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: