Healthcare Provider Details

I. General information

NPI: 1962332122
Provider Name (Legal Business Name): SOPHIA RENNIE LAV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
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

5432 N 81ST PL
SCOTTSDALE AZ
85250-7330
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-24077
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: