Healthcare Provider Details

I. General information

NPI: 1427623701
Provider Name (Legal Business Name): LIBERATION COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 E SEVEN GENERATIONS WAY STE 121
TUCSON AZ
85747-5828
US

IV. Provider business mailing address

10501 E SEVEN GENERATIONS WAY STE 121
TUCSON AZ
85747-5828
US

V. Phone/Fax

Practice location:
  • Phone: 520-833-4290
  • Fax: 888-972-9484
Mailing address:
  • Phone: 520-833-4290
  • Fax: 888-972-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DENA M OMAR
Title or Position: OWNER
Credential: LCSW
Phone: 520-833-4290