Provider Demographics
NPI:1477642262
Name:ESPERERO FAMILY CENTER
Entity type:Organization
Organization Name:ESPERERO FAMILY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-326-8424
Mailing Address - Street 1:3131 N COUNTRY CLUB RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1651
Mailing Address - Country:US
Mailing Address - Phone:520-326-8424
Mailing Address - Fax:520-326-8669
Practice Address - Street 1:3131 N COUNTRY CLUB RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1651
Practice Address - Country:US
Practice Address - Phone:520-326-8424
Practice Address - Fax:520-326-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH1199251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107012OtherAHCCCS