Healthcare Provider Details

I. General information

NPI: 1528781473
Provider Name (Legal Business Name): MICHAEL TUGENDHAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15804 E BRITTLEBUSH LN
FOUNTAIN HILLS AZ
85268-3183
US

IV. Provider business mailing address

15804 E BRITTLEBUSH LN
FOUNTAIN HILLS AZ
85268-3183
US

V. Phone/Fax

Practice location:
  • Phone: 571-314-6385
  • Fax:
Mailing address:
  • Phone: 571-314-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22969
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: