Healthcare Provider Details

I. General information

NPI: 1699366849
Provider Name (Legal Business Name): PATRICK K VARNEY MA, MS, LAC, LASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2021
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE 204
PHOENIX AZ
85016-4661
US

IV. Provider business mailing address

4539 N 22ND ST STE 204
PHOENIX AZ
85016-4661
US

V. Phone/Fax

Practice location:
  • Phone: 602-628-8791
  • Fax:
Mailing address:
  • Phone: 602-628-8791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-155282
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLAC-20776
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: