MEDICARE: SOUTHWEST ADULT ASPERGERS ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	3378	AZ

General Provider Information

NPI Number	:	1043452303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ADULT ASPERGERS ASSOCIATION

Provider Business Mailing Address
First Line	:	5010 W SWEETWATER DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-9064
Country	:	US
Telephone Number	:	520-743-9789
Fax Number	:	520-743-1577

Provider Business Practice Location Address
First Line	:	5010 W SWEETWATER DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-9064
Country	:	US
Telephone Number	:	520-743-9789
Fax Number	:	520-743-1577

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. BARBARA JANE NICHOLS
Credential	:	PH.D.
Telephone Number	:	520-743-9789

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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