Mark Gonchar, LASAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

13156 Issued in AZ

Practice address

3095 E Coronado TRL
Rimrock, AZ 86335-5284

Phone

(928) 567-1322

NPI assigned

Sep 11, 2018

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Copper Canyon Academy

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Rimrock, AZ
  • NPI 1205070786
  NPD (past)
• Copper Canyon Academy

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Lake Montezuma, AZ
  • NPI 1275978900
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 11, 2018.

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1003399403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230",
            "city": "RIMROCK",
            "state": "AZ",
            "postal_code": "863350230",
            "telephone_number": "928-567-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 E CORONADO TRL",
            "city": "RIMROCK",
            "state": "AZ",
            "postal_code": "863355284",
            "telephone_number": "928-567-1322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONCHAR",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "LASAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-11",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "13156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Copper Canyon Academy
• Rodney Kent Courtney, CEP
• Kelly C Donohue, PHD
• Emoticare Rimrock LLC.
• Tamara Cy Garden, LPC
• Clay Conrad Khin
• Lake Montezuma RTC, LLC
• Katie McAndrew, SLPA
• Ingvild Mikkelborg, MA
• Montezuma Rimrock Fire District

• All providers in Rimrock, AZ
• Addiction (Substance Use Disorder) Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.