MEDICARE: INERTIA COUNSELING 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	LCSW-16879	AZ

General Provider Information

NPI Number	:	1619474350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INERTIA COUNSELING LLC

Provider Business Mailing Address
First Line	:	4639 E 6TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2907
Country	:	US
Telephone Number	:	520-390-1442
Fax Number	:

Provider Business Practice Location Address
First Line	:	4639 E 6TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2907
Country	:	US
Telephone Number	:	520-390-1442
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	KEVIN OCAIN
Credential	:	LCSW
Telephone Number	:	520-390-1442

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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