MEDICARE: AZ FAMILY THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW2595	AZ

General Provider Information

NPI Number	:	1043635758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZ FAMILY THERAPY LLC

Provider Business Mailing Address
First Line	:	1661 N. SWAN RD
Second Line	:	SUITE 244
City	:	TUCSON
State	:	AZ
Zip	:	85712-4053
Country	:	US
Telephone Number	:	520-327-5522
Fax Number	:	520-327-5525

Provider Business Practice Location Address
First Line	:	1661 N. SWAN RD
Second Line	:	SUITE 244
City	:	TUCSON
State	:	AZ
Zip	:	85712-4053
Country	:	US
Telephone Number	:	520-327-5522
Fax Number	:	520-327-5525

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH R LEINWEBER
Credential	:	LCSW
Telephone Number	:	520-327-5522

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/04/2014

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