MEDICARE: MR. MICHAEL TUMA LPC, LCDC

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	17876	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	10276	TX

General Provider Information

NPI Number	:	1639868839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL TUMA LPC, LCDC

Provider Business Mailing Address
First Line	:	7521 LOS PADRES TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-3510
Country	:	US
Telephone Number	:	817-694-0826
Fax Number	:

Provider Business Practice Location Address
First Line	:	7521 LOS PADRES TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-3510
Country	:	US
Telephone Number	:	817-694-0826
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/03/2023

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