Provider Demographics
NPI:1457493645
Name:PRESTON, JO ANN C (LISAC)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:C
Last Name:PRESTON
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 W SAN XAVIER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-7238
Mailing Address - Country:US
Mailing Address - Phone:520-879-6060
Mailing Address - Fax:520-879-6099
Practice Address - Street 1:7490 S CAMINO DE OESTE
Practice Address - Street 2:7402 S. CAMINO VAHCOM
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-9308
Practice Address - Country:US
Practice Address - Phone:520-879-6060
Practice Address - Fax:520-879-6099
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-1578101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ846727Medicaid
AZ054317Medicaid
AZ218075Medicaid