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NPI Code Detail

MEDICARE: JUDITH HECKENLAIBLE-HABIG LAC, LASAC

MEDICARE: JUDITH HECKENLAIBLE-HABIG LAC, LASAC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLASAC-13236AZ
2101YP2500XProfessional CounselorLAC-14553AZ

General Provider Information

NPI Number : 1770960338
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH HECKENLAIBLE-HABIG LAC, LASAC
Provider Business Mailing Address
First Line : PO BOX 72450
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-1025
Country : US
Telephone Number : 602-486-2541
Fax Number :
Provider Business Practice Location Address
First Line : 229 W CANTERBURY LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-6284
Country : US
Telephone Number : 602-486-2541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2015
Last Update Date : 05/04/2015

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