MEDICARE: JASON KLARER LAC

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	101Y00000X	Counselor	LAC-17384	AZ

General Provider Information

NPI Number	:	1285114413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON KLARER LAC

Provider Business Mailing Address
First Line	:	6534 W PIUTE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 W PEORIA AVE STE A101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4721
Country	:	US
Telephone Number	:	602-600-1871
Fax Number	:

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

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	12/29/2020

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