Provider Demographics
NPI:1659314177
Name:JUNGE, MICHAEL (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:JUNGE
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 W ZACHARY DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-6094
Mailing Address - Country:US
Mailing Address - Phone:602-751-1384
Mailing Address - Fax:623-322-4819
Practice Address - Street 1:3137 W ZACHARY DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-6094
Practice Address - Country:US
Practice Address - Phone:602-751-1384
Practice Address - Fax:623-322-4819
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool