Provider Demographics
NPI:1639961683
Name:UMHAY, JEREMY (LIAC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:UMHAY
Suffix:
Gender:M
Credentials:LIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 S APACHE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7514
Mailing Address - Country:US
Mailing Address - Phone:480-593-8468
Mailing Address - Fax:
Practice Address - Street 1:2290 S APACHE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7514
Practice Address - Country:US
Practice Address - Phone:480-593-8468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ155353101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)