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General NPI Number Information
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NPI Number | 1194137315
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Entity Type | Organization
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Legal Business Name | COMMUNITY INTERVENTION ASSOCIATES
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 2851 S AVENUE B BLDG 4
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City | YUMA
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State | AZ
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Zip | 85364-7726
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Country | US
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Telephone | 928-376-0026
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Fax | 928-782-2298
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Provider Business Mailing Address
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Address Line | 2851 S. AVE. B. BLDG 4
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City | YUMA
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State | AZ
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Zip | 85364-0710
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Country | US
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Telephone | 928-376-0026
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Fax | 928-782-2298
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | JOSE RAMON BUCIO
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Credential | LPC
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Telephone | 928-376-0026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LPC-14075
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC-14075
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License Number State | AZ
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