Healthcare Provider Details

I. General information

NPI: 1740913086
Provider Name (Legal Business Name): MICHAEL LUSHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 E PECOS RD STE 119
GILBERT AZ
85295-8052
US

IV. Provider business mailing address

16025 S 50TH ST APT 2168
PHOENIX AZ
85048-5020
US

V. Phone/Fax

Practice location:
  • Phone: 480-721-2660
  • Fax:
Mailing address:
  • Phone: 501-538-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: