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General NPI Number Information
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NPI Number | 1043297906
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Entity Type | Individual
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Provider Name | MICHELLE MCLOUGHLIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 4175 S ALAMO AVE
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City | TUCSON
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State | AZ
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Zip | 85707-4402
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Country | US
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Telephone | 520-228-2104
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Fax |
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Provider Business Mailing Address
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Address Line | 6520 E CALLE CAPPELA
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City | TUCSON
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State | AZ
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Zip | 85710-5607
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-2928
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License Number State | AZ
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