Provider Demographics
NPI:1851725212
Name:LACASSE, MINDY BESS (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:BESS
Last Name:LACASSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6512
Mailing Address - Country:US
Mailing Address - Phone:602-955-7997
Mailing Address - Fax:602-954-0980
Practice Address - Street 1:3825 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6512
Practice Address - Country:US
Practice Address - Phone:602-955-7997
Practice Address - Fax:602-954-0980
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-12717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional