MEDICARE: ARIZONA CENTER FOR INNOVATIVE STRESS & TRAUMA TREATMENT 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	251S00000X	Community/Behavioral Health Agency	LCSW-11577	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982061156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA CENTER FOR INNOVATIVE STRESS & TRAUMA TREATMENT LLC

Provider Business Mailing Address
First Line	:	2913 E 22ND ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-2001
Country	:	US
Telephone Number	:	520-303-1697
Fax Number	:	520-347-3959

Provider Business Practice Location Address
First Line	:	2913 E 22ND ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-2001
Country	:	US
Telephone Number	:	520-303-1697
Fax Number	:	520-347-3959

Authorized Official
Title or Position	:	CLINICAL DIRECTOR/THERAPIST
Name	:	DR. NORMA MAGDALENO
Credential	:	DBH, LCSW
Telephone Number	:	520-444-9138

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	05/03/2024

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