MEDICARE: MS. RACHEL MICHELE TOMBAUGH MA, 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	13724	AZ

General Provider Information

NPI Number	:	1952610545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL MICHELE TOMBAUGH MA, LPC

Provider Business Mailing Address
First Line	:	38031 N 21ST AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-8377
Country	:	US
Telephone Number	:	602-446-2222
Fax Number	:	602-346-0117

Provider Business Practice Location Address
First Line	:	4150 W PEORIA AVE
Second Line	:	SUITE 133
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3900
Country	:	US
Telephone Number	:	602-446-2222
Fax Number	:	602-346-0117

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	07/13/2015

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