MEDICARE: LISA NAMM

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	101YM0800X	Mental Health Counselor	18507	AZ

General Provider Information

NPI Number	:	1033871967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA NAMM

Provider Business Mailing Address
First Line	:	3201 W PEORIA AVE STE A200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4699
Country	:	US
Telephone Number	:	602-525-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 W PEORIA AVE STE A200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4699
Country	:	US
Telephone Number	:	602-525-2018
Fax Number	:

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

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	09/17/2025

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Directions to “ LISA NAMM ” Practice Location

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