Individual
KY S RESH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1601 N TUCSON BLVD, SUITE 36, TUCSON, AZ 85716-3425
(520) 320-9996
(520) 323-3739
Mailing address
PO BOX 41002, TUCSON, AZ 85717-1002
(520) 320-9996
(520) 323-3739
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW10508
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
756489
—
AZ
Enumeration date
07/16/2006
Last updated
07/08/2007
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