Provider Demographics
NPI:1881465771
Name:MUGISHA, PEARL JANEPHER
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:JANEPHER
Last Name:MUGISHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7663 W FLYNN LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-2941
Mailing Address - Country:US
Mailing Address - Phone:858-905-1164
Mailing Address - Fax:
Practice Address - Street 1:2034 E SOUTHERN AVE STE U
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7519
Practice Address - Country:US
Practice Address - Phone:858-905-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG13087101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)