Provider Demographics
NPI:1326325986
Name:MUGGE, MICHELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MUGGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39506 N DAISY MOUNTAIN DR
Mailing Address - Street 2:SUITE 122, BOX 225
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1663
Mailing Address - Country:US
Mailing Address - Phone:623-295-9288
Mailing Address - Fax:
Practice Address - Street 1:2730 W AGUA FRIA FWY
Practice Address - Street 2:SUITE 200, OFFICE E-17
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-7201
Practice Address - Country:US
Practice Address - Phone:623-295-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional