MEDICARE: CMG COUNSELING PLLC

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	1041C0700X	Clinical Social Worker	LCSW-12230	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063743326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMG COUNSELING PLLC

Provider Business Mailing Address
First Line	:	10501 E SEVEN GENERATIONS WAY
Second Line	:	#121
City	:	TUCSON
State	:	AZ
Zip	:	85747-5828
Country	:	US
Telephone Number	:	520-975-2028
Fax Number	:	520-207-0892

Provider Business Practice Location Address
First Line	:	10501 E SEVEN GENERATIONS WAY
Second Line	:	#121
City	:	TUCSON
State	:	AZ
Zip	:	85747-5828
Country	:	US
Telephone Number	:	520-975-2028
Fax Number	:	520-207-0892

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	CASSANDRA M GORMAN
Credential	:	LCSW
Telephone Number	:	520-975-2028

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	10/19/2013

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