MEDICARE: PATIENCE MUKASA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063108561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATIENCE MUKASA

Provider Business Mailing Address
First Line	:	4040 E MCDOWELL RD STE 402
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 E MCDOWELL RD STE 402
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4448
Country	:	US
Telephone Number	:	602-880-1327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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Directions to “ PATIENCE MUKASA ” Practice Location

Language	Start Address	Practice Location

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