Healthcare Provider Details

I. General information

NPI: 1427181460
Provider Name (Legal Business Name): DEBORAH L HOAG LISAC MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH L FINLEY

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SHOW LOW LAKE ROAD
SHOW LOW AZ
85901
US

IV. Provider business mailing address

2550 SHOW LOW LAKE ROAD
SHOW LOW AZ
85901
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-1029
  • Fax: 928-537-9049
Mailing address:
  • Phone: 928-537-1029
  • Fax: 928-537-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC10573
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: