Individual provider Active NPI

Nicholas T. Puchalski, LMFT

  • Marriage & Family Therapist
  • Gilbert, AZ
National Provider Identifier
1700255148
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
15340 Issued in AZ
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

Updated by the provider on May 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
15340AZMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Restored Counseling & Wellness Center, PLLC Marriage & Family Therapist Current Accepting new patients
Hoy & Associates Inc. PastSince Apr 23, 2024 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.

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.

Verify at the official NPI Registry.