1942413364 NPI number — QUARTZSITE ELEMENTARY SCHOOL DISTRICT #4

Table of content: DUSTEE GIBSON MA LPC (NPI 1528511672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942413364 NPI number — QUARTZSITE ELEMENTARY SCHOOL DISTRICT #4

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUARTZSITE ELEMENTARY SCHOOL DISTRICT #4
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942413364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EHRENBERG
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85334-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-923-7900
Provider Business Mailing Address Fax Number:
928-923-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49241 PARKER EHRENBERG HWY.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EHRENBERG
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-923-7907
Provider Business Practice Location Address Fax Number:
928-923-8908
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CUNNINGHAM
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DISTRICT BUSINESS MANAGER
Authorized Official Telephone Number:
928-923-7907

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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