MEDICARE: ENTUNE BEHAVIORAL HEALTH 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	1041C0700X	Clinical Social Worker
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1477333482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTUNE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2850 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1910
Country	:	US
Telephone Number	:	520-322-6274
Fax Number	:	520-509-4496

Provider Business Practice Location Address
First Line	:	6303 E TANQUE VERDE RD STE 210
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3859
Country	:	US
Telephone Number	:	520-896-1400
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ED HUDSON
Credential	:
Telephone Number	:	520-322-6274

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	12/12/2023

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