Provider Demographics
NPI:1699514273
Name:PETER TUMOLO, PLLC.
Entity type:Organization
Organization Name:PETER TUMOLO, PLLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:TUMOLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-227-6440
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 1:793 N ALMA SCHOOL RD STE D-6
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3681
Practice Address - Country:US
Practice Address - Phone:480-227-6440
Practice Address - Fax:855-566-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health