Provider Demographics
NPI:1114704970
Name:FICKES, KRISTIN (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:FICKES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14300 N NORTHSIGHT BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3676
Mailing Address - Country:US
Mailing Address - Phone:480-388-9985
Mailing Address - Fax:
Practice Address - Street 1:14300 N NORTHSIGHT BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3676
Practice Address - Country:US
Practice Address - Phone:480-388-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health