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General NPI Number Information
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NPI Number | 1518395870
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Entity Type | Organization
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Legal Business Name | OASIS ADDICTION COUNSELING LLC
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 711 S GRANITE ST SUITE A
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City | PRESCOTT
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State | AZ
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Zip | 86303-4241
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Country | US
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Telephone | 928-533-4220
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Fax |
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Provider Business Mailing Address
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Address Line | 711 S GRANITE ST SUITE A
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City | PRESCOTT
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State | AZ
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Zip | 86303-4241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MATTHEW LUCHINI
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Credential |
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Telephone | 928-533-4220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | BH-3905
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License Number State | AZ
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