MEDICARE: DESERT HOPE PSYCHOTHERAPY AND CONSULTATION SERVICES, 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	106H00000X	Marriage & Family Therapist	LMFT-0325	AZ

General Provider Information

NPI Number	:	1427370048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT HOPE PSYCHOTHERAPY AND CONSULTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	2767 N DESERT AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1957
Country	:	US
Telephone Number	:	520-326-2919
Fax Number	:	520-326-2919

Provider Business Practice Location Address
First Line	:	2767 N DESERT AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1957
Country	:	US
Telephone Number	:	520-326-2919
Fax Number	:	520-326-2919

Authorized Official
Title or Position	:	MARRIAGE AND FAMILY THERAPIST
Name	:	MR. STEVEN LYNN LEGENDRE
Credential	:	M.A., M.P.A
Telephone Number	:	520-326-2919

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	02/23/2010

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