Healthcare Provider Details

I. General information

NPI: 1457877052
Provider Name (Legal Business Name): KARENA CASON MA, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16815 S DESERT FOOTHILLS PKWY STE 134
PHOENIX AZ
85048-8465
US

IV. Provider business mailing address

5428 N MESQUITE BOSQUE WAY
TUCSON AZ
85704-1759
US

V. Phone/Fax

Practice location:
  • Phone: 602-339-0353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-6406T
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberBH5025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: