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General NPI Number Information
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NPI Number | 1891102265
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Entity Type | Organization
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Legal Business Name | ARIZONA INTEGRATED MEDICINE, LLC
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 6336 N ORACLE RD STE 326-276
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City | TUCSON
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State | AZ
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Zip | 85704-5480
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Country | US
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Telephone | 520-907-1730
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Fax | 520-797-3250
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Provider Business Mailing Address
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Address Line | 6336 N ORACLE RD STE 326276
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City | TUCSON
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State | AZ
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Zip | 85704-5480
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Country | US
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Telephone | 520-907-1730
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Fax | 520-797-3250
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. SUSAN ELLEN HEGEMEYER
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Credential | DBH
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Telephone | 520-907-1730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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