Provider Demographics
NPI:1326776873
Name:A LIVING ROOM ON BROADWAY, PLLC
Entity Type:Organization
Organization Name:A LIVING ROOM ON BROADWAY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER-POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LASAC
Authorized Official - Phone:520-954-5454
Mailing Address - Street 1:5051 N SABINO CANYON RD UNIT 1147
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6457
Mailing Address - Country:US
Mailing Address - Phone:520-954-5454
Mailing Address - Fax:
Practice Address - Street 1:5051 N SABINO CANYON RD UNIT 1147
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-6457
Practice Address - Country:US
Practice Address - Phone:520-954-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A LIVING ROOM ON BROADWAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty