Provider Demographics
NPI:1326349101
Name:CACTUS COUNSELING ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CACTUS COUNSELING ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LENERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MC, LAC
Authorized Official - Phone:520-798-3659
Mailing Address - Street 1:110 S CHURCH AVE
Mailing Address - Street 2:SUITE 2070
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1608
Mailing Address - Country:US
Mailing Address - Phone:520-798-3659
Mailing Address - Fax:520-903-0309
Practice Address - Street 1:110 S CHURCH AVE
Practice Address - Street 2:SUITE 2070
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1608
Practice Address - Country:US
Practice Address - Phone:520-798-3659
Practice Address - Fax:520-903-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3672251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health