Healthcare Provider Details

I. General information

NPI: 1265163950
Provider Name (Legal Business Name): MICHAEL PELAEZ LAMFT-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 N 16TH ST STE 219
PHOENIX AZ
85020-5257
US

IV. Provider business mailing address

7227 N 16TH ST STE 219
PHOENIX AZ
85020-5257
US

V. Phone/Fax

Practice location:
  • Phone: 602-492-7150
  • Fax:
Mailing address:
  • Phone: 602-492-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLAMFT-08156T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: