Healthcare Provider Details

I. General information

NPI: 1407023658
Provider Name (Legal Business Name): JAN SICKLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N MILLER RD
SCOTTSDALE AZ
85251-3619
US

IV. Provider business mailing address

4300 N MILLER RD
SCOTTSDALE AZ
85251-3619
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-4247
  • Fax: 480-427-4010
Mailing address:
  • Phone: 480-941-4247
  • Fax: 480-427-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10181
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: