MEDICARE: MR. MICHAEL LEE PUGH MSW, LMFT

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	106H00000X	Marriage & Family Therapist	000502-042579	TX

General Provider Information

NPI Number	:	1851497101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL LEE PUGH MSW, LMFT

Provider Business Mailing Address
First Line	:	6022 GREEN TERRACE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-5421
Country	:	US
Telephone Number	:	713-542-3671
Fax Number	:	281-260-7119

Provider Business Practice Location Address
First Line	:	6022 GREEN TERRACE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-5421
Country	:	US
Telephone Number	:	713-542-3671
Fax Number	:	281-260-7119

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/09/2007

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