MEDICARE: MS. COLLEEN F CREWS-SIPE LISAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LISAC-11430	AZ

General Provider Information

NPI Number	:	1760883466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN F CREWS-SIPE LISAC

Provider Business Mailing Address
First Line	:	3003 N CENTRAL AVE STE 400
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2929
Country	:	US
Telephone Number	:	602-685-6000
Fax Number	:	602-302-7925

Provider Business Practice Location Address
First Line	:	262 E UNIVERSITY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-5932
Country	:	US
Telephone Number	:	602-685-6000
Fax Number	:	602-389-3780

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

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	11/04/2025

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