Healthcare Provider Details

I. General information

NPI: 1093180309
Provider Name (Legal Business Name): MYRIAD COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 E SKYLINE DR SUITE 114
TUCSON AZ
85718-1666
US

IV. Provider business mailing address

4525 E SKYLINE DR SUITE 114
TUCSON AZ
85718-1666
US

V. Phone/Fax

Practice location:
  • Phone: 520-395-5277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LISA GOLDSTONE
Title or Position: CO-OWNER
Credential: MS, PHARMD
Phone: 520-395-5277