Provider Demographics
NPI:1588432975
Name:TCHUDI, MICHAEL (APCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TCHUDI
Suffix:
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:MOJO
Other - Middle Name:
Other - Last Name:TCHUDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9335
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-1335
Mailing Address - Country:US
Mailing Address - Phone:530-588-0324
Mailing Address - Fax:530-588-0324
Practice Address - Street 1:3164 CONDO CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2557
Practice Address - Country:US
Practice Address - Phone:708-523-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC14216101YP2500X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional