Healthcare Provider Details

I. General information

NPI: 1417608019
Provider Name (Legal Business Name): JACQUELINE M BACHELIER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4527 N 16TH ST STE 200
PHOENIX AZ
85016-5354
US

IV. Provider business mailing address

2153 E DONALD DR
PHOENIX AZ
85024-6545
US

V. Phone/Fax

Practice location:
  • Phone: 623-401-9408
  • Fax:
Mailing address:
  • Phone: 602-689-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22601
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: