Provider Demographics
NPI:1043984362
Name:RUSTAEY, AMELIA KEIANA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:KEIANA
Last Name:RUSTAEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 E BROADWAY BLVD STE 202-1
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1720
Mailing Address - Country:US
Mailing Address - Phone:520-534-0525
Mailing Address - Fax:
Practice Address - Street 1:64 E BROADWAY BLVD STE 202-1
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1720
Practice Address - Country:US
Practice Address - Phone:520-534-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health