Provider Demographics
NPI:1891712733
Name:RESH, KY S (LCSW)
Entity Type:Individual
Prefix:
First Name:KY
Middle Name:S
Last Name:RESH
Suffix:
Gender:M
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:PO BOX 41002
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85717-1002
Mailing Address - Country:US
Mailing Address - Phone:520-320-9996
Mailing Address - Fax:520-323-3739
Practice Address - Street 1:1601 N TUCSON BLVD
Practice Address - Street 2:SUITE 36
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3425
Practice Address - Country:US
Practice Address - Phone:520-320-9996
Practice Address - Fax:520-323-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW105081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ756489Medicaid
AZ756489Medicaid
AZ100280Medicare ID - Type Unspecified