Provider Demographics
NPI:1902563745
Name:KUMAR, VIKAAS (LAC)
Entity Type:Individual
Prefix:
First Name:VIKAAS
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14040 N CAVE CREEK RD STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6179
Mailing Address - Country:US
Mailing Address - Phone:602-503-0710
Mailing Address - Fax:888-927-0409
Practice Address - Street 1:14040 N CAVE CREEK RD STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6179
Practice Address - Country:US
Practice Address - Phone:602-503-0710
Practice Address - Fax:888-927-0409
Is Sole Proprietor?:No
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20381101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLAC-20381OtherSTATE BOARD OF BEHAVIORAL HEALTH EXAMINERS