MEDICARE: MR. MICHAEL AUSTIN PEUGNET M.S., LASAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LASAC-15107	AZ

General Provider Information

NPI Number	:	1871990861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL AUSTIN PEUGNET M.S., LASAC

Provider Business Mailing Address
First Line	:	4020 N 20TH ST
Second Line	:	SUITE 302
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6028
Country	:	US
Telephone Number	:	602-535-6468
Fax Number	:	602-595-8695

Provider Business Practice Location Address
First Line	:	4020 N 20TH ST
Second Line	:	SUITE 302
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6028
Country	:	US
Telephone Number	:	602-535-6468
Fax Number	:	602-595-8695

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

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	11/19/2014

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