MEDICARE: MR. MALIK BRANDON ASHE LACT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LACT-15205	AZ

General Provider Information

NPI Number	:	1013867779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MALIK BRANDON ASHE LACT

Provider Business Mailing Address
First Line	:	25 S ARIZONA PL
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-5533
Country	:	US
Telephone Number	:	602-345-1337
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 S ARIZONA PL
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-5533
Country	:	US
Telephone Number	:	602-345-1337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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