MEDICARE: LIFE MANAGEMENT CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency
3	261QM0850X	Adult Mental Health Clinic/Center
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1356108088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE MANAGEMENT CENTER

Provider Business Mailing Address
First Line	:	5656 E GRANT RD STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2200
Country	:	US
Telephone Number	:	520-975-3136
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 E GRANT RD STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2200
Country	:	US
Telephone Number	:	520-975-3136
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	EVELYN TOVAR
Credential	:	LCSW/LMSW
Telephone Number	:	520-975-3136

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	02/29/2024

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