Provider Demographics
NPI:1598121865
Name:TUCSON LASTING CONNECTIONS, LLC
Entity Type:Organization
Organization Name:TUCSON LASTING CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIDERMYER STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-820-8871
Mailing Address - Street 1:PO BOX 68485
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8485
Mailing Address - Country:US
Mailing Address - Phone:520-820-8871
Mailing Address - Fax:520-441-5210
Practice Address - Street 1:2120 W INA RD
Practice Address - Street 2:SUITE 103-E
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2694
Practice Address - Country:US
Practice Address - Phone:520-820-8871
Practice Address - Fax:520-441-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-02
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10427251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health