Healthcare Provider Details

I. General information

NPI: 1891102265
Provider Name (Legal Business Name): ARIZONA INTEGRATED MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 N ORACLE RD STE 326-276
TUCSON AZ
85704-5480
US

IV. Provider business mailing address

6336 N ORACLE RD STE 326276
TUCSON AZ
85704-5480
US

V. Phone/Fax

Practice location:
  • Phone: 520-907-1730
  • Fax: 520-797-3250
Mailing address:
  • Phone: 520-907-1730
  • Fax: 520-797-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN ELLEN HEGEMEYER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DBH
Phone: 520-907-1730