Provider Demographics
NPI:1508249541
Name:BISSONETTE, CURTIS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:
Last Name:BISSONETTE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:CURT
Other - Middle Name:
Other - Last Name:BISSONETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:6420 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3534
Mailing Address - Country:US
Mailing Address - Phone:520-235-2054
Mailing Address - Fax:
Practice Address - Street 1:6420 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3534
Practice Address - Country:US
Practice Address - Phone:520-235-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-0467106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMFT-0467OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS