MEDICARE: TUCSON BEHAVIORAL HEALTH SERVICE CORPORATION

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1316413487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCSON BEHAVIORAL HEALTH SERVICE CORPORATION

Provider Business Mailing Address
First Line	:	4400 E BROADWAY BLVD STE 306
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3553
Country	:	US
Telephone Number	:	520-230-8256
Fax Number	:	405-347-7364

Provider Business Practice Location Address
First Line	:	4400 E BROADWAY BLVD STE 306
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3553
Country	:	US
Telephone Number	:	520-230-8256
Fax Number	:	405-347-7364

Authorized Official
Title or Position	:	DNP/PMHNP-BC
Name	:	ESTHER KIOKO
Credential	:	DNP/PMHNP-BC
Telephone Number	:	520-230-8256

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	02/20/2023

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