Individual
SHERILYN THAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6808 S 43RD AVE, LAVEEN, AZ 85339-8533
(480) 275-1056
Mailing address
6808 S 43RD AVE, LAVEEN, AZ 85339
(480) 275-1056
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
SLH10481
AZ
Other
Enumeration date
02/08/2023
Last updated
02/08/2023
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