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General NPI Number Information
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NPI Number | 1700082849
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Entity Type | Organization
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Legal Business Name | L'ETOILE DE LE NORD, INC.
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 37 E SPEEDWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85705-7714
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Country | US
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Telephone | 520-440-1744
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Fax |
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Provider Business Mailing Address
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Address Line | 7440 N BOGERT PL
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City | TUCSON
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State | AZ
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Zip | 85741-1655
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Country | US
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Telephone | 520-440-1744
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JILL MARIE PLEVELL
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Credential | PH.D.
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Telephone | 520-440-1744
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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 | 1957
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License Number State | AZ
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