Healthcare Provider Details

I. General information

NPI: 1790565802
Provider Name (Legal Business Name): JON MICHAEL STRICKLER LASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 S 1ST AVE
PHOENIX AZ
85003-2692
US

IV. Provider business mailing address

3877 N 7TH ST # S400
PHOENIX AZ
85014-5072
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6797
  • Fax: 602-248-8119
Mailing address:
  • Phone: 602-258-6797
  • Fax: 602-248-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLASAC-15481
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: