Healthcare Provider Details

I. General information

NPI: 1114704970
Provider Name (Legal Business Name): KRISTIN FICKES LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN KNIGHT

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 N NORTHSIGHT BLVD STE 205
SCOTTSDALE AZ
85260-3676
US

IV. Provider business mailing address

14300 N NORTHSIGHT BLVD STE 205
SCOTTSDALE AZ
85260-3676
US

V. Phone/Fax

Practice location:
  • Phone: 480-388-9985
  • Fax:
Mailing address:
  • Phone: 480-388-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-21873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: