MEDICARE: DAVID JOHN MUMFORD MS, LPC

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	101YP2500X	Professional Counselor	LPC 12271	AZ

General Provider Information

NPI Number	:	1588744080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JOHN MUMFORD MS, LPC

Provider Business Mailing Address
First Line	:	504 W 29TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-3353
Country	:	US
Telephone Number	:	520-838-5600
Fax Number	:	520-884-3478

Provider Business Practice Location Address
First Line	:	3620 N MOUNTAIN AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1938
Country	:	US
Telephone Number	:	520-320-6285
Fax Number	:	520-882-7504

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	04/29/2015

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