MEDICARE: MR. THOMAS GREGORY MACEWICZ M.A., CRC, 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-16739	AZ

General Provider Information

NPI Number	:	1962857706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS GREGORY MACEWICZ M.A., CRC, LPC

Provider Business Mailing Address
First Line	:	1661 N SWAN RD STE 250
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4053
Country	:	US
Telephone Number	:	520-398-4265
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 N SWAN RD STE 250
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4053
Country	:	US
Telephone Number	:	520-398-4265
Fax Number	:

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

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	05/03/2018

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