Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LMSW17198 | AZ |
NPI | 1003421017 |
---|---|
Provider Name | Michael Katz |
First Address | Tucson, AZ 85710-4651 |
Second Address | Tucson, AZ 85745-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2020 |
Last Update Date | 15/09/2020 |