Individual
TARA FUSILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LASAC
Contact information
Practice address
3050 W AGUA FRIA FWY STE 150, PHOENIX, AZ 85027-3998
(928) 713-1619
Mailing address
3050 W AGUA FRIA FWY STE 150, PHOENIX, AZ 85027-3998
(928) 713-1619
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15247
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LASAC-15247
—
Other
Enumeration date
10/25/2023
Last updated
10/25/2023
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