Healthcare Provider Details

I. General information

NPI: 1760314389
Provider Name (Legal Business Name): SAVANNAH REESE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 106
PHOENIX AZ
85027-4014
US

IV. Provider business mailing address

PO BOX 20216
PHOENIX AZ
85036-0216
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-4600
  • Fax: 602-428-7045
Mailing address:
  • Phone: 480-712-4600
  • Fax: 602-428-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23095
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: