Provider Demographics
NPI:1427831734
Name:LASANE, NICK ELAN
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:ELAN
Last Name:LASANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15555 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2023
Mailing Address - Country:US
Mailing Address - Phone:469-247-8031
Mailing Address - Fax:
Practice Address - Street 1:6344 E BROWN RD STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4843
Practice Address - Country:US
Practice Address - Phone:480-269-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical