Healthcare Provider Details

I. General information

NPI: 1346650710
Provider Name (Legal Business Name): JANE ST PIERRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 N FAIRVIEW AVE #146
TUCSON AZ
85705-3721
US

IV. Provider business mailing address

3115 N FAIRVIEW AVE #146
TUCSON AZ
85705-3721
US

V. Phone/Fax

Practice location:
  • Phone: 520-429-3673
  • Fax:
Mailing address:
  • Phone: 520-429-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCSW 10827
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberLCSW10827
License Number StateAZ

VIII. Authorized Official

Name: MS. JANE ELIZABETH ST. PIERRE
Title or Position: COUNSELOR
Credential: MSW, LCSW
Phone: 520-429-3673