Healthcare Provider Details

I. General information

NPI: 1962880377
Provider Name (Legal Business Name): SISU PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 06/11/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17220 N BOSWELL BLVD STE 206
SUN CITY AZ
85373-2070
US

IV. Provider business mailing address

17220 N BOSWELL BLVD STE 206
SUN CITY AZ
85373-2070
US

V. Phone/Fax

Practice location:
  • Phone: 928-228-0346
  • Fax: 844-464-1201
Mailing address:
  • Phone: 928-228-0346
  • Fax: 844-464-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA STAHURA
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD
Phone: 928-228-0346