Provider Demographics
NPI:1770726184
Name:TUCSON CENTRAL PSYCHIATRY, LLC
Entity type:Organization
Organization Name:TUCSON CENTRAL PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAN DOREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-290-4533
Mailing Address - Street 1:2230 E SPEEDWAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4727
Mailing Address - Country:US
Mailing Address - Phone:520-290-4533
Mailing Address - Fax:
Practice Address - Street 1:2230 E SPEEDWAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4727
Practice Address - Country:US
Practice Address - Phone:520-290-4533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty