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Individual

MR. MICHAEL E. MCCLUSKEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPC, LISAC

Contact information

Practice address
2187 SWANSON AVE, LAKE HAVASU CITY, AZ 86403-6838
(928) 855-3432
Mailing address
PO BOX 1309, LAKE HAVASU CITY, AZ 86405-1309
(928) 855-7493

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC-1414
AZ
101YP2500X
Professional Counselor
Primary
LPC-2374
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
615049
AHCCCS #
AZ
Enumeration date
06/13/2006
Last updated
04/07/2016
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