Susan Lachica, PSYD
Individual provider Active NPI Psychologist · Peridot, AZ
NPI 1508201740 · NPPES record last updated Oct 8, 2025
Key facts
- NPI
- 1508201740
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PSY-004504 (AZ)
- Practice address
- 106 Medicine Way Road
Peridot, AZ 85542 - Phone
- (928) 475-1500
- Fax
- (928) 475-1525
- NPI assigned
- May 1, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAAC-13162 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
| PSY-004504 | AZ | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Carlos Apache Wellness Center | Past | Accepting new patients | |
| San Carlos Apache Tribe | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY-004504 | AZ | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LAAC-13162 | AZ |
Addresses
Primary practice location
106 Medicine Way Road
Peridot, AZ 85542
Mailing address
P.O. Box 0
San Carlos, AZ 85550
Phone (928) 475-1500
Other providers in Peridot, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.