MEDICARE: HUMAN POTENTIAL ARTS 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1912510611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMAN POTENTIAL ARTS LLC

Provider Business Mailing Address
First Line	:	3355 N WILD DAISY PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-3139
Country	:	US
Telephone Number	:	505-336-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 N WILD DAISY PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-3139
Country	:	US
Telephone Number	:	505-336-0088
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JACOB GOTWALS
Credential	:
Telephone Number	:	505-336-0088

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	09/29/2022

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Directions to “HUMAN POTENTIAL ARTS LLC ” Practice Location

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