Healthcare Provider Details

I. General information

NPI: 1588432975
Provider Name (Legal Business Name): MICHAEL TCHUDI LPCC 20961
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOJO TCHUDI

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 TERRACE WAY STE C
SANTA ROSA CA
95404-3065
US

IV. Provider business mailing address

PO BOX 9335
SANTA ROSA CA
95405-1335
US

V. Phone/Fax

Practice location:
  • Phone: 530-518-9250
  • Fax:
Mailing address:
  • Phone: 530-518-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC14216
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: