MEDICARE: MRS. MARIE JOLENE SAINT JUSTE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1720647316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE JOLENE SAINT JUSTE

Provider Business Mailing Address
First Line	:	8218 W ATLANTIS WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1559
Country	:	US
Telephone Number	:	480-843-2969
Fax Number	:	480-525-4983

Provider Business Practice Location Address
First Line	:	8218 W ATLANTIS WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1559
Country	:	US
Telephone Number	:	480-843-2969
Fax Number	:	480-525-4983

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

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	06/07/2019

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