MEDICARE: AMELIA KEIANA RUSTAEY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1043984362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA KEIANA RUSTAEY

Provider Business Mailing Address
First Line	:	64 E BROADWAY BLVD STE 202-1
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-1720
Country	:	US
Telephone Number	:	520-534-0525
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 E BROADWAY BLVD STE 202-1
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-1720
Country	:	US
Telephone Number	:	520-534-0525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/12/2025

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Directions to “ AMELIA KEIANA RUSTAEY ” Practice Location

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