Provider Demographics
NPI:1760714513
Name:LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Other - Org Name:LIFE COUNSELING NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF BEHAVIORAL HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLESSINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-748-2300
Mailing Address - Street 1:5049 E BROADWAY BLVD
Mailing Address - Street 2:#108
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3645
Mailing Address - Country:US
Mailing Address - Phone:520-748-2300
Mailing Address - Fax:520-748-2355
Practice Address - Street 1:5049 E BROADWAY BLVD
Practice Address - Street 2:#108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3645
Practice Address - Country:US
Practice Address - Phone:520-748-2300
Practice Address - Fax:520-748-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3266251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ131303Medicare PIN