Provider Demographics
NPI:1760548242
Name:SHOWALTER, HELENE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HELENE
Middle Name:ANN
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 N SAN BLAS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3134
Mailing Address - Country:US
Mailing Address - Phone:520-591-7589
Mailing Address - Fax:520-297-8216
Practice Address - Street 1:2524 W RUTHRAUFF RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1895
Practice Address - Country:US
Practice Address - Phone:520-591-7589
Practice Address - Fax:520-297-8216
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 15391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ923004Medicaid