Provider Demographics
NPI:1871990861
Name:PEUGNET, MICHAEL AUSTIN (MS, LASAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:AUSTIN
Last Name:PEUGNET
Suffix:
Gender:M
Credentials:MS, LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 N 20TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6028
Mailing Address - Country:US
Mailing Address - Phone:602-535-6468
Mailing Address - Fax:602-595-8695
Practice Address - Street 1:4020 N 20TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6028
Practice Address - Country:US
Practice Address - Phone:602-535-6468
Practice Address - Fax:602-595-8695
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-15107101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)