Healthcare Provider Details

I. General information

NPI: 1932206810
Provider Name (Legal Business Name): MICHAEL J PRATT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12881 166TH ST SUITE 110
CERRITOS CA
90703-2149
US

IV. Provider business mailing address

12881 166TH ST SUITE 110
CERRITOS CA
90703-2149
US

V. Phone/Fax

Practice location:
  • Phone: 562-921-5701
  • Fax: 562-921-5703
Mailing address:
  • Phone: 562-921-5701
  • Fax: 562-921-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: