Healthcare Provider Details

I. General information

NPI: 1588294987
Provider Name (Legal Business Name): MICHAEL ANTHONY DIFALCO LMFT 141550
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 BARON AVE
CLOVIS CA
93612-1205
US

IV. Provider business mailing address

227 BARON AVE
CLOVIS CA
93612-1205
US

V. Phone/Fax

Practice location:
  • Phone: 559-940-2289
  • Fax:
Mailing address:
  • Phone: 559-940-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number117384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: