Provider Demographics
NPI:1740646710
Name:TUMOLO, PETER (LPC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:TUMOLO
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 1:793 N ALMA SCHOOL RD STE D-6
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3681
Mailing Address - Country:US
Mailing Address - Phone:480-227-6440
Mailing Address - Fax:855-566-9645
Practice Address - Street 1:3610 N 44TH ST STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6060
Practice Address - Country:US
Practice Address - Phone:602-218-6901
Practice Address - Fax:602-492-9717
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15145101YM0800X
AZLPC-15145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health