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General NPI Number Information
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NPI Number | 1629697644
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Entity Type | Organization
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Legal Business Name | MAITRI WELLNESS, PLLC
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 1431 W MAGEE RD
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City | TUCSON
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State | AZ
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Zip | 85704-2116
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Country | US
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Telephone | 520-262-0787
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Fax | 520-244-1681
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Provider Business Mailing Address
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Address Line | 2450 E AVENIDA DE POSADA
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City | TUCSON
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State | AZ
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Zip | 85718-3057
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Country | US
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Telephone | 520-262-0787
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Fax | 520-244-1681
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN PROEBSTING
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Credential | PHD
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Telephone | 520-262-0787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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