Most Relevant Information
Provider Data
| NPI Number: | 1003426545 |
| Provider Name: | MATTHEW AARON LASSLO |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: | LAC-17209 |
Most Important Dates
| Enumeration Date: | 08/07/2020 |
| Last Updated: | 08/07/2020 |
Provider Practice Location
463 S LAKE POWELL BLVD
PAGE
AZ
860400856
Practice Location Phone/Fax
| Phone: | 9286455113 |
| Fax: | 9286453254 |
Provider Mailing Location
PO BOX 790
PAGE
AZ
860400790
Provider Mailing Phone/Fax
| Phone: | 9286455113 |
| Fax: | 9286453254 |