Provider Demographics
NPI:1972684280
Name:MAY, PATRICIA L (LISAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:MAY
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N MESQUITE ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4019
Mailing Address - Country:US
Mailing Address - Phone:928-634-2236
Mailing Address - Fax:928-634-8960
Practice Address - Street 1:8 E COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4382
Practice Address - Country:US
Practice Address - Phone:928-634-2236
Practice Address - Fax:928-634-8960
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ877920Medicaid