MEDICARE: MRS. SONYA M ANDERSEN-HAILE 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	101YM0800X	Mental Health Counselor	LAC-17698	AZ

General Provider Information

NPI Number	:	1588256002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SONYA M ANDERSEN-HAILE LAC

Provider Business Mailing Address
First Line	:	2033 E WARNER RD STE 111
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-3417
Country	:	US
Telephone Number	:	623-294-8647
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 E WARNER RD STE 111
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-3417
Country	:	US
Telephone Number	:	623-294-8647
Fax Number	:

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

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	03/09/2026

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