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General NPI Number Information
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NPI Number | 1215615521
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE JEFFERY LAC
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Gender | Female
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 2222 W PINNACLE PEAK RD STE 320
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City | PHOENIX
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State | AZ
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Zip | 85027-1229
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Country | US
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Telephone | 602-703-2742
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Fax |
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Provider Business Mailing Address
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Address Line | 16814 N 46TH LN
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City | GLENDALE
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State | AZ
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Zip | 85306-1522
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Country | US
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Telephone | 623-570-7436
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LAC-21441
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License Number State | AZ
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