Provider Demographics
NPI:1982061156
Name:ARIZONA CENTER FOR INNOVATIVE STRESS & TRAUMA TREATMENT LLC
Entity type:Organization
Organization Name:ARIZONA CENTER FOR INNOVATIVE STRESS & TRAUMA TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGDALENO
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, LCSW
Authorized Official - Phone:520-444-9138
Mailing Address - Street 1:2913 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-2001
Mailing Address - Country:US
Mailing Address - Phone:520-303-1697
Mailing Address - Fax:520-347-3959
Practice Address - Street 1:2913 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-2001
Practice Address - Country:US
Practice Address - Phone:520-303-1697
Practice Address - Fax:520-347-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-11577251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ456065Medicaid