Provider Demographics
NPI:1497366314
Name:STANDIFER, CACHORA (BHT MRT)
Entity Type:Individual
Prefix:MR
First Name:CACHORA
Middle Name:
Last Name:STANDIFER
Suffix:
Gender:M
Credentials:BHT MRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6294 S EAGLES TALON PKWY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-1639
Mailing Address - Country:US
Mailing Address - Phone:520-289-1838
Mailing Address - Fax:888-691-1037
Practice Address - Street 1:6294 S EAGLES TALON PKWY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85757-1639
Practice Address - Country:US
Practice Address - Phone:520-289-1838
Practice Address - Fax:888-691-1037
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1083262984Medicaid