Healthcare Provider Details

I. General information

NPI: 1629566351
Provider Name (Legal Business Name): OPTIMA BEHAVIORAL CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W GRANT RD STE 180
TUCSON AZ
85745-1475
US

IV. Provider business mailing address

1955 W GRANT RD STE 180
TUCSON AZ
85745-1475
US

V. Phone/Fax

Practice location:
  • Phone: 844-333-6642
  • Fax: 520-333-3060
Mailing address:
  • Phone: 844-333-6642
  • Fax: 520-333-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ARIELLE KUZDAL
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 520-500-7505