Healthcare Provider Details

I. General information

NPI: 1548665359
Provider Name (Legal Business Name): LASSITER COUNSELING SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S WILLIAMS BLVD SUITE 260
TUCSON AZ
85711-4496
US

IV. Provider business mailing address

350 S WILLIAMS BLVD SUITE 260
TUCSON AZ
85711-4496
US

V. Phone/Fax

Practice location:
  • Phone: 520-591-8721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-15355
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-15355
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberLPC-15355
License Number StateAZ

VIII. Authorized Official

Name: FREDERICK LASSITER JR.
Title or Position: OWNER/PROFESSIONAL COUNSELOR
Credential:
Phone: 520-591-8721