Provider Demographics
NPI:1760548622
Name:ARIZONA FAMILY THERAPY CLINIC INC
Entity Type:Organization
Organization Name:ARIZONA FAMILY THERAPY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR CO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEINWEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW BCD
Authorized Official - Phone:520-327-5522
Mailing Address - Street 1:PO BOX 64002
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-4002
Mailing Address - Country:US
Mailing Address - Phone:520-327-5522
Mailing Address - Fax:520-327-5525
Practice Address - Street 1:1661 N SWAN RD
Practice Address - Street 2:SUITE 244
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4042
Practice Address - Country:US
Practice Address - Phone:520-327-5522
Practice Address - Fax:520-327-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
83510Medicare ID - Type Unspecified