MEDICARE: MS. CAROLYN SUE HUNTSMAN ME.D.

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	101YP2500X	Professional Counselor	LPC #11741	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11741	OTHER	AZ	LPC

General Provider Information

NPI Number	:	1881883254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN SUE HUNTSMAN ME.D.

Provider Business Mailing Address
First Line	:	1536 EAST MARYLAND AVE
Second Line	:	SUITE B104
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1469
Country	:	US
Telephone Number	:	480-201-3113
Fax Number	:	602-595-9911

Provider Business Practice Location Address
First Line	:	7921 E SAN MIGUEL AVE
Second Line	:	#5
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-6558
Country	:	US
Telephone Number	:	480-219-5633
Fax Number	:	602-595-9911

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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