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General NPI Number Information
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NPI Number | 1184265647
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Entity Type | Individual
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Provider Name | KEVIN CHRISTOPHER LASAC
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Gender | Male
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 6424 E GREENWAY PKWY STE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-2045
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Country | US
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Telephone | 480-877-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 6928 E GRANDVIEW DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1552
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Country | US
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Telephone | 602-446-2895
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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-13280
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License Number State | AZ
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