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General NPI Number Information
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NPI Number | 1538667316
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Entity Type | Organization
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Legal Business Name | SUNTELEO LLC
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 723 COVE PKWY STE C
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4685
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Country | US
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Telephone | 928-301-2640
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 545
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City | CORNVILLE
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State | AZ
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Zip | 86325-0545
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Country | US
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Telephone | 928-301-2640
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JOY LIVINGSTON
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Credential | LCSW
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Telephone | 928-301-2640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW-12681
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License Number State | AZ
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