Provider Demographics
NPI:1184349748
Name:MARTZ, DANI RANAE (LISAC)
Entity type:Individual
Prefix:
First Name:DANI
Middle Name:RANAE
Last Name:MARTZ
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 1:916 E DIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3222
Mailing Address - Country:US
Mailing Address - Phone:480-695-8805
Mailing Address - Fax:
Practice Address - Street 1:10287 E. OSBORN RD.
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85256
Practice Address - Country:US
Practice Address - Phone:602-785-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-15176101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)