Healthcare Provider Details

I. General information

NPI: 1285367136
Provider Name (Legal Business Name): CASEY BENJAMIN STONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6945 E JULIA ST
TUCSON AZ
85710-4819
US

IV. Provider business mailing address

6945 E JULIA ST
TUCSON AZ
85710-4819
US

V. Phone/Fax

Practice location:
  • Phone: 520-204-6676
  • Fax:
Mailing address:
  • Phone: 520-204-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number466358
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-19684
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: