Provider Demographics
NPI:1134281504
Name:CENTER FOR LIFE SKILLS DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:CENTER FOR LIFE SKILLS DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEWUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:MC, NCC, LPC
Authorized Official - Phone:520-229-6220
Mailing Address - Street 1:2231 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2650
Mailing Address - Country:US
Mailing Address - Phone:520-229-6220
Mailing Address - Fax:520-544-3033
Practice Address - Street 1:2231 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2650
Practice Address - Country:US
Practice Address - Phone:520-229-6220
Practice Address - Fax:520-544-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty