MEDICARE: CASSIE URIBE COUNSELING & CONSULTING, PLLC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1376152470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSIE URIBE COUNSELING & CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	19 W CALLE PRISCAL
Second Line	:
City	:	SAHUARITA
State	:	AZ
Zip	:	85629-6606
Country	:	US
Telephone Number	:	520-870-4528
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 E BROADWAY BLVD STE 202-10
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-1720
Country	:	US
Telephone Number	:	253-345-4036
Fax Number	:	253-201-4819

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MRS. CASSANDRA URIBE
Credential	:	LICSW
Telephone Number	:	253-345-4036

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	10/12/2022

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