Provider Demographics
NPI:1306832704
Name:CUYAR, MARCO ANTONIO (MS, LPC, LISAC, NCC)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ANTONIO
Last Name:CUYAR
Suffix:
Gender:M
Credentials:MS, LPC, LISAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14524
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-4524
Mailing Address - Country:US
Mailing Address - Phone:480-497-4720
Mailing Address - Fax:480-284-7278
Practice Address - Street 1:1234 S POWER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3700
Practice Address - Country:US
Practice Address - Phone:480-497-4720
Practice Address - Fax:480-284-7278
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10577101YA0400X
AZLPC-10810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831546Medicaid