Provider Demographics
NPI:1790565802
Name:STRICKLER, JON MICHAEL (LASAC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MICHAEL
Last Name:STRICKLER
Suffix:
Gender:M
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 E SOLINA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3290
Mailing Address - Country:US
Mailing Address - Phone:602-463-4699
Mailing Address - Fax:
Practice Address - Street 1:3050 W AGUA FRIA FWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3946
Practice Address - Country:US
Practice Address - Phone:602-463-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-15481101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)