MEDICARE: AVERY ELIZABETH LACKNER 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-23785	AZ

General Provider Information

NPI Number	:	1902754120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY ELIZABETH LACKNER LAC

Provider Business Mailing Address
First Line	:	690 N MANN AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6885 N ORACLE RD STE D
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-4222
Country	:	US
Telephone Number	:	425-998-7448
Fax Number	:

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

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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