Provider Demographics
NPI:1316413487
Name:TUCSON BEHAVIORAL HEALTH SERVICE CORPORATION
Entity Type:Organization
Organization Name:TUCSON BEHAVIORAL HEALTH SERVICE CORPORATION
Other - Org Name:TUCSON BEHAVIORAL HEALTH SERVICE CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DNP/PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIOKO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP/PMHNP-BC
Authorized Official - Phone:520-230-8256
Mailing Address - Street 1:4400 E BROADWAY BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3553
Mailing Address - Country:US
Mailing Address - Phone:520-230-8256
Mailing Address - Fax:405-347-7364
Practice Address - Street 1:4400 E BROADWAY BLVD STE 306
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3553
Practice Address - Country:US
Practice Address - Phone:520-230-8256
Practice Address - Fax:405-347-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty