Healthcare Provider Details

I. General information

NPI: 1669283214
Provider Name (Legal Business Name): MICHAEL LECHUGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 N 7TH ST
PHOENIX AZ
85014-5005
US

IV. Provider business mailing address

3318 S HARDY DR
TEMPE AZ
85282-4773
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6797
  • Fax:
Mailing address:
  • Phone: 303-620-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22105
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: