Healthcare Provider Details

I. General information

NPI: 1609141191
Provider Name (Legal Business Name): MICHAEL ISRAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LAKESHORE DR STE 415
TEMPE AZ
85282-7056
US

IV. Provider business mailing address

6250 S 40TH ST 8027
PHOENIX AZ
85042
US

V. Phone/Fax

Practice location:
  • Phone: 623-324-6544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22551
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: