Healthcare Provider Details

I. General information

NPI: 1699514273
Provider Name (Legal Business Name): PETER TUMOLO, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 N ALMA SCHOOL RD STE D-6
CHANDLER AZ
85224-3681
US

IV. Provider business mailing address

793 N ALMA SCHOOL RD STE D-6
CHANDLER AZ
85224-3681
US

V. Phone/Fax

Practice location:
  • Phone: 480-227-6440
  • Fax: 855-566-9645
Mailing address:
  • Phone: 480-227-6440
  • Fax: 855-566-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER IAN TUMOLO
Title or Position: OWNER
Credential: LPC
Phone: 480-227-6440