Provider Demographics
NPI:1821815671
Name:MOLZAHN, LUCRETIA (LAC)
Entity type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:
Last Name:MOLZAHN
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 1:1025 CLEARWATER CT
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-7936
Mailing Address - Country:US
Mailing Address - Phone:928-208-7145
Mailing Address - Fax:
Practice Address - Street 1:1025 CLEARWATER CT
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-7936
Practice Address - Country:US
Practice Address - Phone:928-208-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23114101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor