Provider Demographics
NPI:1366738783
Name:JAKACHIRA, AISHA A (MS, LPC, CSAC)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:A
Last Name:JAKACHIRA
Suffix:
Gender:F
Credentials:MS, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36295
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6295
Mailing Address - Country:US
Mailing Address - Phone:414-688-4806
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 36295
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85740-6295
Practice Address - Country:US
Practice Address - Phone:414-688-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15690-131101YA0400X
WI15665-132101YA0400X
WI5578-125101YP2500X
AZ16412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42021500Medicaid