Organization
SOULISTIC MEDICAL INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARAYEH CUNNINGHAM PH.D. (MANAGING DIRECTOR)
(520) 398-3970
Entity
Organization
Contact information
Practice address
26 TUBAC ROAD, SUITE B, TUBAC, AZ 85646
(520) 398-3970
(520) 398-2944
Mailing address
PO BOX 1990, TUBAC, AZ 85646-1990
(520) 398-3970
(520) 398-2944
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
3784
AZ
207Q00000X
Family Medicine Physician
Primary
27940
AZ
Other
Enumeration date
05/08/2006
Last updated
11/29/2011
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