MEDICARE: PETER TUMOLO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	15145	AZ
2	101YP2500X	Professional Counselor	LPC-15145	AZ

General Provider Information

NPI Number	:	1740646710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER TUMOLO LPC

Provider Business Mailing Address
First Line	:	793 N ALMA SCHOOL RD STE D-6
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3681
Country	:	US
Telephone Number	:	480-227-6440
Fax Number	:	855-566-9645

Provider Business Practice Location Address
First Line	:	3610 N 44TH ST STE 120
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-6060
Country	:	US
Telephone Number	:	602-218-6901
Fax Number	:	602-492-9717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	05/22/2024

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Directions to “ PETER TUMOLO LPC” Practice Location

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