Healthcare Provider Details

I. General information

NPI: 1215687967
Provider Name (Legal Business Name): COURTNEY JADE KUCERA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 E VIA DE VENTURA STE 280
SCOTTSDALE AZ
85258-4541
US

IV. Provider business mailing address

8700 E VIA DE VENTURA STE 280
SCOTTSDALE AZ
85258-4541
US

V. Phone/Fax

Practice location:
  • Phone: 480-674-9220
  • Fax:
Mailing address:
  • Phone: 480-674-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-20763
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC23759
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: