Provider Demographics
NPI:1699366849
Name:VARNEY, PATRICK K (MA, MS, LAC, LASAC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:K
Last Name:VARNEY
Suffix:
Gender:M
Credentials:MA, MS, LAC, LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 N 22ND ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4661
Mailing Address - Country:US
Mailing Address - Phone:602-628-8791
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4661
Practice Address - Country:US
Practice Address - Phone:602-628-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-31
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20776101YP2500X
AZLISAC-155282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional