Provider Demographics
NPI:1659075554
Name:MISCHKE, LORRAINE (LASAC)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:MISCHKE
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 N 78TH ST APT 157B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2548
Mailing Address - Country:US
Mailing Address - Phone:480-567-2235
Mailing Address - Fax:
Practice Address - Street 1:4425 N 78TH ST APT 157B
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2548
Practice Address - Country:US
Practice Address - Phone:480-567-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-15313101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)