Provider Demographics
NPI:1760883466
Name:CREWS-SIPE, COLLEEN F (LISAC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:F
Last Name:CREWS-SIPE
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:F
Other - Last Name:SIPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISAC
Mailing Address - Street 1:202 E. EARLL DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2647
Mailing Address - Country:US
Mailing Address - Phone:602-808-2800
Mailing Address - Fax:602-599-5711
Practice Address - Street 1:621 W. SOUTHERN AVE.
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5004
Practice Address - Country:US
Practice Address - Phone:602-599-5570
Practice Address - Fax:602-599-5711
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11430101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)