Provider Demographics
NPI:1619207123
Name:SOURS, DAN D (LPC)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:D
Last Name:SOURS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 W PEORIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5211
Mailing Address - Country:US
Mailing Address - Phone:602-548-8508
Mailing Address - Fax:602-548-1201
Practice Address - Street 1:3101 W PEORIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5211
Practice Address - Country:US
Practice Address - Phone:602-548-8508
Practice Address - Fax:602-548-1201
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC11995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional