Healthcare Provider Details

I. General information

NPI: 1144502162
Provider Name (Legal Business Name): CENTER FOR LIFE SKILLS DEVELOPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N ALVERNON WAY
TUCSON AZ
85712-3369
US

IV. Provider business mailing address

2001 W. ORANGE GROVE ROAD, SUITE 612
TUCSON AZ
85704
US

V. Phone/Fax

Practice location:
  • Phone: 520-546-1642
  • Fax: 520-325-0436
Mailing address:
  • Phone: 520-546-1642
  • Fax: 520-325-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBH3833
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH3833
License Number StateAZ

VIII. Authorized Official

Name: MRS. ROBERTA ANN LEWUSZ
Title or Position: CEO/CO-OWNER
Credential: M.C.,L.P.C.
Phone: 520-904-9701