Provider Demographics
NPI:1972835312
Name:SUGARMAN, GARY I (LPC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:I
Last Name:SUGARMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5610
Mailing Address - Country:US
Mailing Address - Phone:520-322-5820
Mailing Address - Fax:
Practice Address - Street 1:2450 E SPEEDWAY BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4734
Practice Address - Country:US
Practice Address - Phone:520-322-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1512101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor