Active NPI
Nicholas T. Puchalski, LMFT
- Marriage & Family Therapist
- Gilbert, AZ
National Provider Identifier
1700255148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 15340
- Practice address
- 633 E Ray Rd Ste 131
Gilbert, AZ 85296-4206 - Phone
- (480) 256-2829
- NPI assigned
- Sep 16, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | |||
| Marriage & Family Therapist | 106H00000X | 15340 | AZ | Primary |
Addresses
Primary practice location
633 E Ray Rd Ste 131
Gilbert, AZ 85296-4206
Mailing address
8401 Wayzata Blvd Ste 150
Golden Valley, MN 55426-1343
Phone (763) 544-1006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15340 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Restored Counseling & Wellness Center, PLLC | Marriage & Family Therapist | Current | Accepting new patients |
| Hoy & Associates Inc. | Past | Accepting new patients |
Locations
633 E Ray Rd
Ste 131
Gilbert, AZ 85296
Phone (480) 256-2829
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Naturopath
- Gilbert, AZ
- NPI 1952090938
Marriage & Family Therapist
-
- Community/Behavioral Health Agency
- Golden Valley, MN
- NPI 1831239003
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682899200000",
"number": "1700255148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8401 WAYZATA BLVD STE 150",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554261343",
"telephone_number": "763-544-1006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 E RAY RD STE 131",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852964206",
"telephone_number": "480-256-2829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCHALSKI",
"first_name": "NICHOLAS",
"middle_name": "T.",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-16",
"last_updated": "2023-05-01",
"certification_date": "2023-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "AZ",
"license": "15340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.