Healthcare Provider Details

I. General information

NPI: 1003746603
Provider Name (Legal Business Name): SARAH HANLEY LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W MARYLAND AVE STE B
PHOENIX AZ
85013-1325
US

IV. Provider business mailing address

1063 S BLOSSOM
MESA AZ
85206-2940
US

V. Phone/Fax

Practice location:
  • Phone: 602-281-3206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-17705
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: