Healthcare Provider Details

I. General information

NPI: 1679089189
Provider Name (Legal Business Name): SHAWNA TREMOULIS MS, LASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W RAY RD
CHANDLER AZ
85226-2470
US

IV. Provider business mailing address

PO BOX 1114
EAGAR AZ
85925-1114
US

V. Phone/Fax

Practice location:
  • Phone: 480-418-1696
  • Fax: 602-569-4328
Mailing address:
  • Phone: 602-796-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLASAC-15445
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: