Healthcare Provider Details

I. General information

NPI: 1104721232
Provider Name (Legal Business Name): JORDAN HILL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 E MAIN ST APT 201
SCOTTSDALE AZ
85251-4574
US

IV. Provider business mailing address

21655 N 36TH AVE UNIT 122
GLENDALE AZ
85308-2074
US

V. Phone/Fax

Practice location:
  • Phone: 480-800-9303
  • Fax:
Mailing address:
  • Phone: 602-931-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24416
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: