MEDICARE: CENTER FOR LIFE SKILLS DEVELOPMENT, LLC

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	BH-2276	AZ

General Provider Information

NPI Number	:	1134281504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR LIFE SKILLS DEVELOPMENT, LLC

Provider Business Mailing Address
First Line	:	2231 W INA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2650
Country	:	US
Telephone Number	:	520-229-6220
Fax Number	:	520-544-3033

Provider Business Practice Location Address
First Line	:	2231 W INA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2650
Country	:	US
Telephone Number	:	520-229-6220
Fax Number	:	520-544-3033

Authorized Official
Title or Position	:	CHIEF EXECUTIVE MANAGER
Name	:	MS. ROBERTA ANN LEWUSZ
Credential	:	M.C., N.C.C., L.P.C.
Telephone Number	:	520-229-6220

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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