Healthcare Provider Details

I. General information

NPI: 1548858434
Provider Name (Legal Business Name): KATIE PLUKAS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S MCCLINTOCK DR STE 101
TEMPE AZ
85282-2691
US

IV. Provider business mailing address

4539 N 22ND ST STE N
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 623-343-3928
  • Fax:
Mailing address:
  • Phone: 360-584-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-24780
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: