Provider Demographics
NPI:1609960335
Name:PRESIDIO COUNSELING INCORPORATED
Entity Type:Organization
Organization Name:PRESIDIO COUNSELING INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:AROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:520-514-2211
Mailing Address - Street 1:2224 N CRAYCROFT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2811
Mailing Address - Country:US
Mailing Address - Phone:520-514-2211
Mailing Address - Fax:520-514-2215
Practice Address - Street 1:2224 N CRAYCROFT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2811
Practice Address - Country:US
Practice Address - Phone:520-514-2211
Practice Address - Fax:520-514-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH 3727251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ477259OtherAHCCCS PROVIDER ID