Provider Demographics
NPI:1962880377
Name:SISU PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:SISU PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHURA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:928-228-0346
Mailing Address - Street 1:17220 N BOSWELL BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-2070
Mailing Address - Country:US
Mailing Address - Phone:928-228-0346
Mailing Address - Fax:844-464-1201
Practice Address - Street 1:17220 N BOSWELL BLVD STE 206
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-2070
Practice Address - Country:US
Practice Address - Phone:928-228-0346
Practice Address - Fax:844-464-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ988196Medicaid
AZZ249020OtherMEDICARE