Healthcare Provider Details

I. General information

NPI: 1942755236
Provider Name (Legal Business Name): JESSICA L LASCARIS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA BLASI

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W UNION HILLS DR
PHOENIX AZ
85027-5163
US

IV. Provider business mailing address

334 W 35TH ST
SAN PEDRO CA
90731-6896
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax:
Mailing address:
  • Phone: 785-770-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1555
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number723
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number15816
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2606
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: