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General NPI Number Information
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NPI Number | 1003467838
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Entity Type | Individual
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Provider Name | YOTONYA RENE FRANKLIN LASAC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 1522 E ADAMS ST
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City | PHOENIX
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State | AZ
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Zip | 85034-1123
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Country | US
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Telephone | 602-252-4743
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Fax |
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Provider Business Mailing Address
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Address Line | 1938 E BRILL ST
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City | PHOENIX
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State | AZ
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Zip | 85006-3019
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Country | US
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Telephone | 602-571-3263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LASAC-15274
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License Number State | AZ
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