Jessica Icha Sambrano, MS, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LAC-08232T Issued in AZ

Practice address

7121 W Bell Rd Ste 240
Glendale, AZ 85308-8559

Phone

(602) 529-1463

NPI assigned

Nov 12, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1609690122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12618 W INDIANOLA AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926326",
            "telephone_number": "480-748-9652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7121 W BELL RD STE 240",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088559",
            "telephone_number": "602-529-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMBRANO",
        "first_name": "JESSICA",
        "middle_name": "ICHA",
        "credential": "MS, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LAC-08232T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.