=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790565802
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JON MICHAEL STRICKLER LASAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2023
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1209 S 1ST AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85003-2692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-258-6797
-----------------------------------------------------
Fax | 602-248-8119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3877 N 7TH ST # S400
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-5072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-258-6797
-----------------------------------------------------
Fax | 602-248-8119
-----------------------------------------------------
=====================================================
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-15481
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------