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NPI Code Detail

MEDICARE: MS. ROCHELLE RYAN LAC

MEDICARE: MS. ROCHELLE RYAN 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
1101YM0800XMental Health CounselorLAC12009AZ
2101YP2500XProfessional Counselor
3101YP2500XProfessional CounselorLPC12829AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LAC12009OTHERAZLICENSE

General Provider Information

NPI Number : 1295931400
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROCHELLE RYAN LAC
Provider Business Mailing Address
First Line : 4747 N 7TH ST STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-3654
Country : US
Telephone Number : 602-279-7655
Fax Number : 602-241-5756
Provider Business Practice Location Address
First Line : 1840 N 95TH AVE STE 160
Second Line :
City : PHOENIX
State : AZ
Zip : 85037-4313
Country : US
Telephone Number : 623-234-9811
Fax Number : 623-234-9815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2007
Last Update Date : 08/10/2022

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Directions to “ MS. ROCHELLE RYAN LAC” Practice Location

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