MEDICARE: SUSAN YAP LASSITER LPC

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	101YP2500X	Professional Counselor	LPC-10907	AZ
2	101YP2500X	Professional Counselor	3684	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	426315	OTHER	AZ	VALUE OPTIONS PROVIDER
2	159731	OTHER	AZ	MHN MANAGED CARE PANEL

General Provider Information

NPI Number	:	1164416970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN YAP LASSITER LPC

Provider Business Mailing Address
First Line	:	7452 E KIOWA AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-6239
Country	:	US
Telephone Number	:	480-250-6602
Fax Number	:

Provider Business Practice Location Address
First Line	:	288 N IRONWOOD DR
Second Line	:	110
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85220-3830
Country	:	US
Telephone Number	:	480-982-2356
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/08/2007

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