Provider Demographics
NPI:1336150085
Name:SUTTON-RYAN, ALISON D (LCSW, LISAC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:D
Last Name:SUTTON-RYAN
Suffix:
Gender:F
Credentials:LCSW, LISAC
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 68028
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8028
Mailing Address - Country:US
Mailing Address - Phone:520-245-8962
Mailing Address - Fax:520-219-4174
Practice Address - Street 1:6050 N ORACLE RD
Practice Address - Street 2:HEARTLINE HEALING CENTER SUITE I
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5314
Practice Address - Country:US
Practice Address - Phone:520-245-8962
Practice Address - Fax:520-219-4174
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 104401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ089086Medicaid