Organization
CREOSOTE MENTAL HEALTH GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD MOSHER PHD (FOUNDER/DIRECTOR)
(520) 307-6495
Entity
Organization
Contact information
Practice address
4646 N SWAN RD STE 105, TUCSON, AZ 85718-6715
(520) 307-6495
Mailing address
1327 E ZULEMA LOOP, TUCSON, AZ 85706-4415
(520) 307-6495
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053801316
GENERAL
AZ
05
—
1053801316
—
AZ
Enumeration date
08/23/2020
Last updated
08/23/2020
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