Provider Demographics
NPI:1699210328
Name:DASSELE, AIMEE (MS, LAC)
Entity Type:Individual
Prefix:MISS
First Name:AIMEE
Middle Name:
Last Name:DASSELE
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-4730
Mailing Address - Country:US
Mailing Address - Phone:602-712-0234
Mailing Address - Fax:602-712-0235
Practice Address - Street 1:145 E 1300 S
Practice Address - Street 2:SUITE 107
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5482
Practice Address - Country:US
Practice Address - Phone:801-783-1950
Practice Address - Fax:801-953-0147
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-15184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional