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General NPI Number Information
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NPI Number | 1265975239
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Entity Type | Individual
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Provider Name | JENNIE DALCOUR LAC
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Gender | Female
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 3603 N 7TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85013-1024
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Country | US
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Telephone | 602-287-9125
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Fax |
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Provider Business Mailing Address
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Address Line | 17333 W RED BIRD RD
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City | SURPRISE
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State | AZ
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Zip | 85387-1024
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Country | US
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Telephone | 623-693-0219
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LAC16280
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License Number State | AZ
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