Healthcare Provider Details

I. General information

NPI: 1407391915
Provider Name (Legal Business Name): DIANNA VANSANFORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LOGAN LIAC

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BELL ROCK PLZ
SEDONA AZ
86351-9044
US

IV. Provider business mailing address

PO BOX 21113
SEDONA AZ
86341-1113
US

V. Phone/Fax

Practice location:
  • Phone: 928-977-9744
  • Fax: 928-852-2112
Mailing address:
  • Phone: 928-977-9744
  • Fax: 928-852-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-16423
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: