=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386163574
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI BASALDU LASAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8322 E HARTFORD DR
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-712-4600
-----------------------------------------------------
Fax | 602-425-7045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8322 E HARTFORD DR
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-712-4600
-----------------------------------------------------
Fax | 602-425-7045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LASAC-13266
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------