Provider Demographics
NPI:1366828725
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:CEO/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEWUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:520-904-9701
Mailing Address - Street 1:2001 W ORANGE GROVE RD STE 612
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1141
Mailing Address - Country:US
Mailing Address - Phone:520-904-9701
Mailing Address - Fax:520-544-3033
Practice Address - Street 1:2001 W. ORANGE GROVE ROAD, SUITE 604
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-904-9701
Practice Address - Fax:520-544-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6315251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health