MEDICARE: LETHA GRADY

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	101YP2500X	Professional Counselor	LPC	AZ

General Provider Information

NPI Number	:	1083072375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETHA GRADY

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE C-104
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3641
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:

Provider Business Practice Location Address
First Line	:	5055 E BROADWAY BLVD STE C-104
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3641
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2016

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Directions to “ LETHA GRADY ” Practice Location

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