Provider Demographics
NPI:1144980277
Name:TUGGLE, MICHELLE PACEE (LCDC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PACEE
Last Name:TUGGLE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 FM 2181 STE 230-517
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4219
Mailing Address - Country:US
Mailing Address - Phone:800-972-0643
Mailing Address - Fax:214-279-5032
Practice Address - Street 1:7535 OAKMONT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4237
Practice Address - Country:US
Practice Address - Phone:800-972-0643
Practice Address - Fax:214-279-5032
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15895101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15895OtherSTATE LICENSE