Healthcare Provider Details

I. General information

NPI: 1316229339
Provider Name (Legal Business Name): CENTER FOR LIFE SKILLS DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5700 E. PIMA STREET SUITE E
TUCSON AZ
85712
US

IV. Provider business mailing address

5700 E. PIMA STREET SUITE E
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-885-1738
  • Fax: 520-546-7608
Mailing address:
  • Phone: 520-885-1738
  • Fax: 520-546-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBH3832
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH3832
License Number StateAZ

VIII. Authorized Official

Name: MRS. ROBERTA ANN LEWUSZ
Title or Position: CHIEF EX MGR/CO-OWNER
Credential: MC, LPC
Phone: 520-904-9701